78
----- Renewal Application Second Generation Open Enrollment Charter Renewal Application Fast-Track! Abbreviated Renewal Schools Eligible for Fast-Track Renewal April 18, 2002 Texas Education Agency William B. Travis Building 1701 North Congress Avenue Austin. Texas 78701-1494 rB) [E [E \Yl [E rRl Ifll JU N 2 2f)03 il1!J Charter Schools Dated Material--Open Immediately Return on or before-5:00 p.m., Central Time Friday, June 14,2002 Charter Schools Division Room 5-107

Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

  • Upload
    others

  • View
    0

  • Download
    0

Embed Size (px)

Citation preview

Page 1: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

--------~--------------

Renewal Application

Second Generation Open Enrollment Charter

Renewal Application

Fast-Track Abbreviated Renewal

Schools Eligible for Fast-Track Renewal

April 18 2002

Texas Education Agency William B Travis Building

1701 North Congress Avenue Austin Texas 78701-1494

rB) [E ~ [E ~ Yl [E rRl Ifll JUN 2 2f)03 il1J

Charter Schools

Dated Material--Open Immediately

Return on or before-500 pm Central Time Friday June 142002

Charter Schools Division Room 5-107

Applieation Instructions

The Renewal Application is due to TEAiCharter Schools Division by 500 pm June 14 2002 Applications will be date stamped as they ate received and the date received will be documented Timely submission ofa complete renewal application may be used as part ofthe basis for renewal detennination

The application fonn has been designed to be downloaded and responses can be entered directly onto the e1ectronic application form on your computer The spaces provided for answering questions ate expandable Use as much space as needed for responses

Attachments should be labeled as indicated in the application and submitted in prescnDed order The fonns for Attachment 3 Board Member Biographical Affidavit and Attachment 5 Electronic Application Certification are included with the application

Seven complete paper copies ofthe entire document must be submitted in prescribed order with only original signahlres in blue ink One copy (less attachments) must aJso be submitted on a 35 inch floppy diskette (The agency uses a PC compatible text file)

Format ofApplication

Number of paper copies 7 Font Paper Binding

12 pt Times New Roman 85xll0 white one side only NONE DO NOT BIND May be rubber-banded or clipped

List 0Attachments

Attachment I OrganizationaJ Chart Attachment 2 CriminaJ History Records for Board Members Attachment 3 Board Member Biographical Affidavits Attachment 4 Special NeedsPrograms Information Request Attachment 5 Electronic Application Certification Attachment 6 Written Resolution Adopted by Governing Body of Charter Holder

Definitions

Please review TEC sect12l012 and 19 TAC Chapter 100 sectlOOlOll for definitions ofterms Listed below are some selected terms and definitions

I Charter holder - the entity to which a charter is granted under TEe Chapter 12

2 Charter school- a Texas public school operated by a charter holder under an open-emollment charter granted by the State Board ofEducation pursuant to TEC sect12101

3 Governing body ofa charter holder - the board ofdirectors board of trustees or other governing body ofa charter holder

4 Governing body ofan open~nrollment charter school- the board ofdirectorsor other governing body ofan open_ enrollment charter school The term includes the governing body ofa charter holder ifthat body acts as the governing body ofthe open-emollment charter school

5 Management company - a person other than a charter holder who provides management services fur an open_ enrollment charter school

6 Officer ofan open~nrollment charter school- the principal director or other chief operating officer ofan openshyenrollment charter school an assistant principal or assistant director ofan open-enrollment charter school or a person charged with managing the finances ofan open-emol1ment charter school

General Scope ofAgency Review

As authorized in Texas Education Code sect 12115 the commissioner may modify place on probation revoke or deny renewal ofthe charter ofan open-enrolhnent chatter school iftbe commissioner determines that the charter holder

I) conunitted a material violation of the charter including fiIilure to satisfY accountability provisions prescribed by the charter

2) fiIiled to satisfy generally accepted accounting standards offiscal management 3) fiIiled to protect the health safety or weIWe ofthe students enrolled at the school or 4) fiIiled to comply with this subchapter or another applicable law or rule

The Commissioners Rules Concerning Open-Enrolhnent Charter Schools 19 TAC Chapter 100 provides more specific information about commissioner action and intervention and other issues concerning open-enrolhnent charter schools

Internal reviews for aU renewal applications will be conducted by lEA staff in areas such as student performance business operations and fiscal management and compliance Components for determining adequate studentperjOf1M1lCe generally include accountability ratings AEIS indicators and other relevant student performance information as reported by the charter school on this application and as supported by required evidence and documentation

Components for evaluating business andfiscal management generally consist ofa review by the Financial Audits Division ofannual financial andits and other relevant documents

Agency compliance requirements that may be generally considered include but are not limited to timely and accurate submission ofgrant expenditures and evaluations PEIMS reports accountabilityaccreditation information (including data requested prior to on-site visits and fullow-up information sueb as corrective action plans for bilingual and special education programs and P ASlDAS risk levels) assessment requests (including requests for and submission oftesting materials) other special education infunnation governance data student transfer data required by Civil Action 5281 and the renewal appIication

Complaints made against the chatter school through the Agency complaints process may also be considered as well as any issues concerning the health safety and welfure of students

Open-EnroUment Charter School Renewal Application Generation Two - Fast-TrackAbbreviated

Part I Charter Update

Charter Holder Name Mid-Cities Learning Center Inc (ie nonprofit organization institution of higher learning or governmental entity)

Charter School Name Treetops School International

Charter School CountylDistrict 220-80 I

Campus Name(s) County~cUCampus

220-801()()1Treetops International

Section L Maximum EnroUment Grades Served and Geograpbic Boundaries In the spaces below please list the maximum enrollment the grades the charter school serves (indicating ifthere is an approved OED program) and the geographic boundaries

A Maximum Enrollment 480

B Grades Served K-12

Approved GED Program YES 0 NO 8l

c Geographic Boundaries (School Districts) 184-907 Aledo ISO 220-802 ArI Classics Acad 220-919 eanvll ISO 057-905 DaIIas ISO 220-918 EagJe Mountain Saginaw ISO 220-905 FW ISO 220-906 ColleyvilleltJrapevine ISO 220-907 Keller ISO 057middot910 Grand Prarie ISO 220middot916 HEB ISO 220middot920 White Setlemnt ISO 220-902 Birdville ISO 057middot903 Farmers Branch ISO 057-922 Coppell ISO 220-914 Crowley ISO 220middot912 Keonedale ISO 057-803 North Hills Charter 220-904 Everman ISO 220-915 Azle ISO 220-908 Mansfield ISO 220-910 Lake Worth ISO

Dr Mike Saclren

Kathy FJunan Clardy

Shelly Moyers

Coke

Meg Richter

Ray Howard

Janet McEwen

Karen Davidenko

SectiOD n Governance Structure and Procedures Review TEC Sec 12121 and 19 TAC Chapter 100 Division 5 (Charter School Governance) which lists among other things powers and duties that must be exercised by the governing body ofthe charter bolder and nepotism and conflict of interest prohibitions and exceptions

Where indicated list all relatives ofthe members ofthe Governing Body ofthe Charter Holder ofthe Governing Body ofthe Charter School and ofthe Officers ofthe Charter School within the third degree ofconsanguinity or affinity These include your spouse and the following relations to you and to your spouse parents children grandchildren siblings grandparents great-grandparents nieces nephews aunts uncles and great-grandchildren

A Goyeming Body of Charter Holder 1 In the spaces below please list the names ofthe members ofthe governing body ofthe charter bolder the offices held any board members relative within the third degree ofconsanguinity or affinity (see definition above) and any compensation or remuneration from the charter bolder or charter school received by the board members

OJ

President none none

Vice President none none

none none

Treasurer none none

At Large none none

Development none none

Public Relations none none

At none none

2 Will any relative ofthe board member within the third degree ofconsanguinity or affinity (see definition above) be employed by or receive any compensation or remuneration from the charter bolder or the charter school Ifyes provide details in the space provided below YES 0 NO 181

3 Will any boerd members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the cbarter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

4 Will any person who is a relative within the third degree ofconsanguinity or affinity (see definition on page 3) ofa charter school officer (ie a person charged with the duties of or acting as a chief executive officer a central administrator a campus administration officer or a business manager) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YESD NO[8l

B Govemi Bodv g$arter School I Ifthe governance structure includes more than one board (ie a governing body tbat is separate from the governing body ofthe charter holder) in the spaces below please list the names ofthe members ofthe governing body ofthe charter school the offices held any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) and any compensation or remuneration from the charter holder or charter school received by the board members

Board Member Ne Relative(s) Within the Third IJegne Board MemberOfJiuBeid or Couanguinity or AffiDity WOO Compensation or are Also Serting OR the Board RemJaeratiOD Per Year

2 Will any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or the charter school Ifyes provide details in space provided below YES 0 NO 121

3 Will any board members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

C Roles and Responsibilities of Governing Bodies Describe the roles and responsibilities ofboth the charter holder and charter school governing bodies Iftills represents a change from the goveroance structure currently on file with the Agency please indicate that it is a change and describe the difference from the previous structure

The Board ofDirectors is the policy making body ofTreetops International School and Mid-Cities Learning Center It is responsible for establishing the philosophy and objectives ofthe school for the effective implementation ofthese policies their review and evalnation in accordance with TEA requirements No change of duties

D Qamplzational ~hn Crimioll Historv Records BiotranlilaI Affillam bull Submit an organirntional chart Include this document as AttacbmeDt 1 Organizational Chart bull Submit a criminal history record for each board member Include these documents as AttacbmeDt 2 Criminal

History Records for Board Members bull Submit a biographical affidavit for each board member Include these documents as Attachment 3 Board

Member Biographical Affidavit

Section m Teacher QualifICations In the space provided describe the qualifications required for all classroom teachers and other instructional staff Ifthis represents a change from the charter application on file with the Agency or approved amendments please indicate that it is a change and describe the difference from the previous requirement

In with teacher are met with all having a high school Currently all teachers (25) are degreed 8 have masters one is completing her PhD and one has PhD It has been the standard to have a college degree to teach Treetops does not currently receive Title I funds but will insure that in the future all teachers in core areas are college graduates

Section IV Code ofCondurt In the space provided describe the methods used to inform parents and students about school rules and guidelines governing student behavior Include policies regarding student expulsion and suspension and procedures that satisfY due process requirements

posted on page are enrollment as well as distributed at the parent meeting or two days before school opens a copy is also in the office for public review This handbook covers policies on student attendance discipline and general operating guidelines ofthe school Ifthere is a need for discipline the parent is contacted by phone reguaIr mail and certified mail All discipline actions including student suspensions and expulsions are elligible for appeal to the school board but the decision ofthe Board is binding

Section V Complaints In the space provided descnbe the methods used to inform parents students and employees about the procedures for receiving and responding to complaints (Note Under 19 TAC sect 100 II0 l(e) the governing body ofa charter holder shall not delegate final authority to hear or decide employee grievances citizen complaints or parental concerns)

Parents and students a student during the open meeting 2 days prior to explains a grievance The policy is also on the web page (wwwtreetopsotg) is posted in the adtnirutration office and on the buIIetine board in the high school building Employees receive an employee handbook and attend inservice concerning procedures for filing a grievance The grievance policy is I) contact in writing the person grievance is with for a meeting 2) Ifnot resolved submit in writing to the Board ofDiredors the grievance 3) The Board will appoint a grievance conunittee formed ofone Board member a faculty member and a parent to review all written statements and interview all parties 4) Majority decisions by the Board are binding TEA continues to keep a record ofall complaints against Treetops and as complaints are released they are addressed by the school policy

Section VL Admissions PoHey In the space provided describe the time1ine used for admitting students including the application deadline and the process for the admission of students by lottery (Although state law permits students to be accepted on a first come first served basis or through a lottery a charter schoo) that is oversubscribed must use a lottery to be eliaible to receive federal funds)

to TreetoPs is based on being an open enrollment school that uses the lottery system All policies and paperwork has the anti-discrimination statement as required by the TEC (12111) as well as being posted in the office and on the school web page The appliauion period for exempt (returning) students is from Manh 1 through March 28 For new applicants registration will be held from March 29 to April 30 Once the openings have been filled students whose names are not drawn are placed on a waiting list A lottery drawing will be held on March 29 Parents must complete the frist page ofthe enrollment form and provide copies ofsocial security card birth certificate and a copy of shot records before the enrollment may be complete The 2002-2003 enrollment forms may be downloaded and printed Admissions will not be based on gender national orgin ethnicity religion disability academic artistic athletic ability or the district the student would otherwise attend

Section VB Student Performance Goals In the spaces provided below identify the schools academic goals for student learning for the next five years in terms of AEIS base and additional indicators and other relevant performance information

Some accountability standards and criteria for 2004 and 2005 are available in the 2002 ACCOWIIability Manual which is available at TAKS passing standards for Exemplary and Recognized are the same as in 2002 Rating criteria and standards have not yet been determined beyond 2002 for completion rate dropout rate the State-Developed Alternative Assessment (SDAA) and the Academically Acceptable Acceptable rating

A AEIS Base Indicators Describe student performance goals in terms ofAEIS base indicators (ie T AAS scores and dropout rates) Be specific about indicators such as percentage ofstudents passing exams and annual dropout rates Note Campuses rated under the Alternative Education Accountability system may also have student attendance and Texas Learning Inder (lU) growth as base indicators

an years to scores to a level Tutorials are offered at all grade levels in an effort to improve performance scores and ratings There has been significant improvemeot in progress ofprior year TAAS fuilers as reflected in the average TLI Growth reading 2001 1357 as opposed to 750 in 2000 reading 429 to 2000 333 and math improving from 300 to 318 All passing tests went from 2000s score of532 to 583 Annual drop out rate continues to be low (08) and attendance rate continues to be in the 95th percentile AP test rates are 161 from 148 previous year There is a strong movement to offer more AP courses and to improve the reading level ofall students TreetoPs showed a 852 passing reading 574 passing writing and 654 passing math Math continues to show improvement but is the weak spot and is being addressed with change ofpersonnel and totorials Summer school is being offered at no clwge in math to help stmegthen skills our exemptions were below the state average at 06 Campus TLI average growth reflects 832 Out of 14 graduates this year 12 are college bound one is technical school bound and one joined the Air Force

B AEIS Additional Indicators Describe student performance goals in terms ofAEIS additional indicators (ie attendance rates 4-year completion rate college admissions testing and participation in the recommended high school program) Be specific about indicators such as average Texas Learning Index (TLl) growth year-to-year progress and accountability ratings NoteCampuses rated under the Alternative Education Accountability system may also have campus-selected additional indicators

rate was the school year with an annual drop out rate in comparison state average of 13 Every grader takes the PSAT and the PLAN tests at school in an effort to be prepared for the SAT and the ACT The 2001 avg TLI was 7536 and growth from 6704 the previous year

c Othu Relevant Perfonnnce Goas Describe other relevant student performance goals that may be unique to your school

are and enhance their the are offered daily in the morning and afternoons It has become a challenge to raise the of learning for each student that is being met head 011 Learning in cInsters has made a significant difference for our students as they mentor each other and make learning accessible to all Mentoring younger students has not only prepared the mentors in academic learning but also in life skills Comuunity service projects have been used as incentives to learn how to make use ofthe skills obtained in the classroom Community service projects are performed at aJ levels across the campus The TAKS will be readily understood by being prepared with practical examples It is our goal to bring the aCceptable rating to recognized this next year

Section vm Monitoring FoIlowUp Discuss improvements made and other actions taken to address any and aJ findings recommendations or sanctions by TEA including those resulting from monitoring on-site visits or hearings Provide specific information about compliance status with aJ special program indicators including corrective action plans for bilingual and special education programs and about PASIDAS risk levels

In compliance with the DEC review and the CAR visit there have beeu mauy changes at Treetops in splaquoia1 education bilingual and accounting procedures In April aU personnel connected to the adminstration was replaced Currently Region XI handles aU fmancial records pays all bills and issues all checks A fmancial system has been implemented where the hills are coded at the district sent to Region XI for review and checks are cut they are returned to the district for siguature and mailings Region XI is processing payroH PEIMS TRS deposits and health insurance In the 2001-2002 school year Region XI will also he handling aU attendance reporting The audits have beeu late due to previous accounting procedures and previous adminstrations which have aU changed as of April 2001 Bank reconciliations are current accounting reports are current credit cards are no longer being used the budget is in compliance with proper coding penonnel files are complete and documentation is kept in accordance to TEA and standard accounting procedure The CAR has generated ESL training for employees the hiring of two ESL teachers and the implementation ofa bilingual program even though Treetops cnrrently has no ESL students LPAC traioiug has been completed by three stafl memben and LEP procedures including the handbook have been implemented Special education reviews showed that we were laeking in documentation in previous yean Ardia Kentfield a Texas certified diagusotician was hired and has completed bringing aU the forms and files up to state requirements Inserviee was held on Dec 10 for assistive technology as weD as diseussion concerning the CAR visit and compliance The last ofthe doeumentation was seat to Austin on May 30 2001 to com~lete the follow u~visit ~

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 2: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Applieation Instructions

The Renewal Application is due to TEAiCharter Schools Division by 500 pm June 14 2002 Applications will be date stamped as they ate received and the date received will be documented Timely submission ofa complete renewal application may be used as part ofthe basis for renewal detennination

The application fonn has been designed to be downloaded and responses can be entered directly onto the e1ectronic application form on your computer The spaces provided for answering questions ate expandable Use as much space as needed for responses

Attachments should be labeled as indicated in the application and submitted in prescnDed order The fonns for Attachment 3 Board Member Biographical Affidavit and Attachment 5 Electronic Application Certification are included with the application

Seven complete paper copies ofthe entire document must be submitted in prescribed order with only original signahlres in blue ink One copy (less attachments) must aJso be submitted on a 35 inch floppy diskette (The agency uses a PC compatible text file)

Format ofApplication

Number of paper copies 7 Font Paper Binding

12 pt Times New Roman 85xll0 white one side only NONE DO NOT BIND May be rubber-banded or clipped

List 0Attachments

Attachment I OrganizationaJ Chart Attachment 2 CriminaJ History Records for Board Members Attachment 3 Board Member Biographical Affidavits Attachment 4 Special NeedsPrograms Information Request Attachment 5 Electronic Application Certification Attachment 6 Written Resolution Adopted by Governing Body of Charter Holder

Definitions

Please review TEC sect12l012 and 19 TAC Chapter 100 sectlOOlOll for definitions ofterms Listed below are some selected terms and definitions

I Charter holder - the entity to which a charter is granted under TEe Chapter 12

2 Charter school- a Texas public school operated by a charter holder under an open-emollment charter granted by the State Board ofEducation pursuant to TEC sect12101

3 Governing body ofa charter holder - the board ofdirectors board of trustees or other governing body ofa charter holder

4 Governing body ofan open~nrollment charter school- the board ofdirectorsor other governing body ofan open_ enrollment charter school The term includes the governing body ofa charter holder ifthat body acts as the governing body ofthe open-emollment charter school

5 Management company - a person other than a charter holder who provides management services fur an open_ enrollment charter school

6 Officer ofan open~nrollment charter school- the principal director or other chief operating officer ofan openshyenrollment charter school an assistant principal or assistant director ofan open-enrollment charter school or a person charged with managing the finances ofan open-emol1ment charter school

General Scope ofAgency Review

As authorized in Texas Education Code sect 12115 the commissioner may modify place on probation revoke or deny renewal ofthe charter ofan open-enrolhnent chatter school iftbe commissioner determines that the charter holder

I) conunitted a material violation of the charter including fiIilure to satisfY accountability provisions prescribed by the charter

2) fiIiled to satisfy generally accepted accounting standards offiscal management 3) fiIiled to protect the health safety or weIWe ofthe students enrolled at the school or 4) fiIiled to comply with this subchapter or another applicable law or rule

The Commissioners Rules Concerning Open-Enrolhnent Charter Schools 19 TAC Chapter 100 provides more specific information about commissioner action and intervention and other issues concerning open-enrolhnent charter schools

Internal reviews for aU renewal applications will be conducted by lEA staff in areas such as student performance business operations and fiscal management and compliance Components for determining adequate studentperjOf1M1lCe generally include accountability ratings AEIS indicators and other relevant student performance information as reported by the charter school on this application and as supported by required evidence and documentation

Components for evaluating business andfiscal management generally consist ofa review by the Financial Audits Division ofannual financial andits and other relevant documents

Agency compliance requirements that may be generally considered include but are not limited to timely and accurate submission ofgrant expenditures and evaluations PEIMS reports accountabilityaccreditation information (including data requested prior to on-site visits and fullow-up information sueb as corrective action plans for bilingual and special education programs and P ASlDAS risk levels) assessment requests (including requests for and submission oftesting materials) other special education infunnation governance data student transfer data required by Civil Action 5281 and the renewal appIication

Complaints made against the chatter school through the Agency complaints process may also be considered as well as any issues concerning the health safety and welfure of students

Open-EnroUment Charter School Renewal Application Generation Two - Fast-TrackAbbreviated

Part I Charter Update

Charter Holder Name Mid-Cities Learning Center Inc (ie nonprofit organization institution of higher learning or governmental entity)

Charter School Name Treetops School International

Charter School CountylDistrict 220-80 I

Campus Name(s) County~cUCampus

220-801()()1Treetops International

Section L Maximum EnroUment Grades Served and Geograpbic Boundaries In the spaces below please list the maximum enrollment the grades the charter school serves (indicating ifthere is an approved OED program) and the geographic boundaries

A Maximum Enrollment 480

B Grades Served K-12

Approved GED Program YES 0 NO 8l

c Geographic Boundaries (School Districts) 184-907 Aledo ISO 220-802 ArI Classics Acad 220-919 eanvll ISO 057-905 DaIIas ISO 220-918 EagJe Mountain Saginaw ISO 220-905 FW ISO 220-906 ColleyvilleltJrapevine ISO 220-907 Keller ISO 057middot910 Grand Prarie ISO 220middot916 HEB ISO 220middot920 White Setlemnt ISO 220-902 Birdville ISO 057middot903 Farmers Branch ISO 057-922 Coppell ISO 220-914 Crowley ISO 220middot912 Keonedale ISO 057-803 North Hills Charter 220-904 Everman ISO 220-915 Azle ISO 220-908 Mansfield ISO 220-910 Lake Worth ISO

Dr Mike Saclren

Kathy FJunan Clardy

Shelly Moyers

Coke

Meg Richter

Ray Howard

Janet McEwen

Karen Davidenko

SectiOD n Governance Structure and Procedures Review TEC Sec 12121 and 19 TAC Chapter 100 Division 5 (Charter School Governance) which lists among other things powers and duties that must be exercised by the governing body ofthe charter bolder and nepotism and conflict of interest prohibitions and exceptions

Where indicated list all relatives ofthe members ofthe Governing Body ofthe Charter Holder ofthe Governing Body ofthe Charter School and ofthe Officers ofthe Charter School within the third degree ofconsanguinity or affinity These include your spouse and the following relations to you and to your spouse parents children grandchildren siblings grandparents great-grandparents nieces nephews aunts uncles and great-grandchildren

A Goyeming Body of Charter Holder 1 In the spaces below please list the names ofthe members ofthe governing body ofthe charter bolder the offices held any board members relative within the third degree ofconsanguinity or affinity (see definition above) and any compensation or remuneration from the charter bolder or charter school received by the board members

OJ

President none none

Vice President none none

none none

Treasurer none none

At Large none none

Development none none

Public Relations none none

At none none

2 Will any relative ofthe board member within the third degree ofconsanguinity or affinity (see definition above) be employed by or receive any compensation or remuneration from the charter bolder or the charter school Ifyes provide details in the space provided below YES 0 NO 181

3 Will any boerd members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the cbarter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

4 Will any person who is a relative within the third degree ofconsanguinity or affinity (see definition on page 3) ofa charter school officer (ie a person charged with the duties of or acting as a chief executive officer a central administrator a campus administration officer or a business manager) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YESD NO[8l

B Govemi Bodv g$arter School I Ifthe governance structure includes more than one board (ie a governing body tbat is separate from the governing body ofthe charter holder) in the spaces below please list the names ofthe members ofthe governing body ofthe charter school the offices held any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) and any compensation or remuneration from the charter holder or charter school received by the board members

Board Member Ne Relative(s) Within the Third IJegne Board MemberOfJiuBeid or Couanguinity or AffiDity WOO Compensation or are Also Serting OR the Board RemJaeratiOD Per Year

2 Will any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or the charter school Ifyes provide details in space provided below YES 0 NO 121

3 Will any board members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

C Roles and Responsibilities of Governing Bodies Describe the roles and responsibilities ofboth the charter holder and charter school governing bodies Iftills represents a change from the goveroance structure currently on file with the Agency please indicate that it is a change and describe the difference from the previous structure

The Board ofDirectors is the policy making body ofTreetops International School and Mid-Cities Learning Center It is responsible for establishing the philosophy and objectives ofthe school for the effective implementation ofthese policies their review and evalnation in accordance with TEA requirements No change of duties

D Qamplzational ~hn Crimioll Historv Records BiotranlilaI Affillam bull Submit an organirntional chart Include this document as AttacbmeDt 1 Organizational Chart bull Submit a criminal history record for each board member Include these documents as AttacbmeDt 2 Criminal

History Records for Board Members bull Submit a biographical affidavit for each board member Include these documents as Attachment 3 Board

Member Biographical Affidavit

Section m Teacher QualifICations In the space provided describe the qualifications required for all classroom teachers and other instructional staff Ifthis represents a change from the charter application on file with the Agency or approved amendments please indicate that it is a change and describe the difference from the previous requirement

In with teacher are met with all having a high school Currently all teachers (25) are degreed 8 have masters one is completing her PhD and one has PhD It has been the standard to have a college degree to teach Treetops does not currently receive Title I funds but will insure that in the future all teachers in core areas are college graduates

Section IV Code ofCondurt In the space provided describe the methods used to inform parents and students about school rules and guidelines governing student behavior Include policies regarding student expulsion and suspension and procedures that satisfY due process requirements

posted on page are enrollment as well as distributed at the parent meeting or two days before school opens a copy is also in the office for public review This handbook covers policies on student attendance discipline and general operating guidelines ofthe school Ifthere is a need for discipline the parent is contacted by phone reguaIr mail and certified mail All discipline actions including student suspensions and expulsions are elligible for appeal to the school board but the decision ofthe Board is binding

Section V Complaints In the space provided descnbe the methods used to inform parents students and employees about the procedures for receiving and responding to complaints (Note Under 19 TAC sect 100 II0 l(e) the governing body ofa charter holder shall not delegate final authority to hear or decide employee grievances citizen complaints or parental concerns)

Parents and students a student during the open meeting 2 days prior to explains a grievance The policy is also on the web page (wwwtreetopsotg) is posted in the adtnirutration office and on the buIIetine board in the high school building Employees receive an employee handbook and attend inservice concerning procedures for filing a grievance The grievance policy is I) contact in writing the person grievance is with for a meeting 2) Ifnot resolved submit in writing to the Board ofDiredors the grievance 3) The Board will appoint a grievance conunittee formed ofone Board member a faculty member and a parent to review all written statements and interview all parties 4) Majority decisions by the Board are binding TEA continues to keep a record ofall complaints against Treetops and as complaints are released they are addressed by the school policy

Section VL Admissions PoHey In the space provided describe the time1ine used for admitting students including the application deadline and the process for the admission of students by lottery (Although state law permits students to be accepted on a first come first served basis or through a lottery a charter schoo) that is oversubscribed must use a lottery to be eliaible to receive federal funds)

to TreetoPs is based on being an open enrollment school that uses the lottery system All policies and paperwork has the anti-discrimination statement as required by the TEC (12111) as well as being posted in the office and on the school web page The appliauion period for exempt (returning) students is from Manh 1 through March 28 For new applicants registration will be held from March 29 to April 30 Once the openings have been filled students whose names are not drawn are placed on a waiting list A lottery drawing will be held on March 29 Parents must complete the frist page ofthe enrollment form and provide copies ofsocial security card birth certificate and a copy of shot records before the enrollment may be complete The 2002-2003 enrollment forms may be downloaded and printed Admissions will not be based on gender national orgin ethnicity religion disability academic artistic athletic ability or the district the student would otherwise attend

Section VB Student Performance Goals In the spaces provided below identify the schools academic goals for student learning for the next five years in terms of AEIS base and additional indicators and other relevant performance information

Some accountability standards and criteria for 2004 and 2005 are available in the 2002 ACCOWIIability Manual which is available at TAKS passing standards for Exemplary and Recognized are the same as in 2002 Rating criteria and standards have not yet been determined beyond 2002 for completion rate dropout rate the State-Developed Alternative Assessment (SDAA) and the Academically Acceptable Acceptable rating

A AEIS Base Indicators Describe student performance goals in terms ofAEIS base indicators (ie T AAS scores and dropout rates) Be specific about indicators such as percentage ofstudents passing exams and annual dropout rates Note Campuses rated under the Alternative Education Accountability system may also have student attendance and Texas Learning Inder (lU) growth as base indicators

an years to scores to a level Tutorials are offered at all grade levels in an effort to improve performance scores and ratings There has been significant improvemeot in progress ofprior year TAAS fuilers as reflected in the average TLI Growth reading 2001 1357 as opposed to 750 in 2000 reading 429 to 2000 333 and math improving from 300 to 318 All passing tests went from 2000s score of532 to 583 Annual drop out rate continues to be low (08) and attendance rate continues to be in the 95th percentile AP test rates are 161 from 148 previous year There is a strong movement to offer more AP courses and to improve the reading level ofall students TreetoPs showed a 852 passing reading 574 passing writing and 654 passing math Math continues to show improvement but is the weak spot and is being addressed with change ofpersonnel and totorials Summer school is being offered at no clwge in math to help stmegthen skills our exemptions were below the state average at 06 Campus TLI average growth reflects 832 Out of 14 graduates this year 12 are college bound one is technical school bound and one joined the Air Force

B AEIS Additional Indicators Describe student performance goals in terms ofAEIS additional indicators (ie attendance rates 4-year completion rate college admissions testing and participation in the recommended high school program) Be specific about indicators such as average Texas Learning Index (TLl) growth year-to-year progress and accountability ratings NoteCampuses rated under the Alternative Education Accountability system may also have campus-selected additional indicators

rate was the school year with an annual drop out rate in comparison state average of 13 Every grader takes the PSAT and the PLAN tests at school in an effort to be prepared for the SAT and the ACT The 2001 avg TLI was 7536 and growth from 6704 the previous year

c Othu Relevant Perfonnnce Goas Describe other relevant student performance goals that may be unique to your school

are and enhance their the are offered daily in the morning and afternoons It has become a challenge to raise the of learning for each student that is being met head 011 Learning in cInsters has made a significant difference for our students as they mentor each other and make learning accessible to all Mentoring younger students has not only prepared the mentors in academic learning but also in life skills Comuunity service projects have been used as incentives to learn how to make use ofthe skills obtained in the classroom Community service projects are performed at aJ levels across the campus The TAKS will be readily understood by being prepared with practical examples It is our goal to bring the aCceptable rating to recognized this next year

Section vm Monitoring FoIlowUp Discuss improvements made and other actions taken to address any and aJ findings recommendations or sanctions by TEA including those resulting from monitoring on-site visits or hearings Provide specific information about compliance status with aJ special program indicators including corrective action plans for bilingual and special education programs and about PASIDAS risk levels

In compliance with the DEC review and the CAR visit there have beeu mauy changes at Treetops in splaquoia1 education bilingual and accounting procedures In April aU personnel connected to the adminstration was replaced Currently Region XI handles aU fmancial records pays all bills and issues all checks A fmancial system has been implemented where the hills are coded at the district sent to Region XI for review and checks are cut they are returned to the district for siguature and mailings Region XI is processing payroH PEIMS TRS deposits and health insurance In the 2001-2002 school year Region XI will also he handling aU attendance reporting The audits have beeu late due to previous accounting procedures and previous adminstrations which have aU changed as of April 2001 Bank reconciliations are current accounting reports are current credit cards are no longer being used the budget is in compliance with proper coding penonnel files are complete and documentation is kept in accordance to TEA and standard accounting procedure The CAR has generated ESL training for employees the hiring of two ESL teachers and the implementation ofa bilingual program even though Treetops cnrrently has no ESL students LPAC traioiug has been completed by three stafl memben and LEP procedures including the handbook have been implemented Special education reviews showed that we were laeking in documentation in previous yean Ardia Kentfield a Texas certified diagusotician was hired and has completed bringing aU the forms and files up to state requirements Inserviee was held on Dec 10 for assistive technology as weD as diseussion concerning the CAR visit and compliance The last ofthe doeumentation was seat to Austin on May 30 2001 to com~lete the follow u~visit ~

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 3: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Definitions

Please review TEC sect12l012 and 19 TAC Chapter 100 sectlOOlOll for definitions ofterms Listed below are some selected terms and definitions

I Charter holder - the entity to which a charter is granted under TEe Chapter 12

2 Charter school- a Texas public school operated by a charter holder under an open-emollment charter granted by the State Board ofEducation pursuant to TEC sect12101

3 Governing body ofa charter holder - the board ofdirectors board of trustees or other governing body ofa charter holder

4 Governing body ofan open~nrollment charter school- the board ofdirectorsor other governing body ofan open_ enrollment charter school The term includes the governing body ofa charter holder ifthat body acts as the governing body ofthe open-emollment charter school

5 Management company - a person other than a charter holder who provides management services fur an open_ enrollment charter school

6 Officer ofan open~nrollment charter school- the principal director or other chief operating officer ofan openshyenrollment charter school an assistant principal or assistant director ofan open-enrollment charter school or a person charged with managing the finances ofan open-emol1ment charter school

General Scope ofAgency Review

As authorized in Texas Education Code sect 12115 the commissioner may modify place on probation revoke or deny renewal ofthe charter ofan open-enrolhnent chatter school iftbe commissioner determines that the charter holder

I) conunitted a material violation of the charter including fiIilure to satisfY accountability provisions prescribed by the charter

2) fiIiled to satisfy generally accepted accounting standards offiscal management 3) fiIiled to protect the health safety or weIWe ofthe students enrolled at the school or 4) fiIiled to comply with this subchapter or another applicable law or rule

The Commissioners Rules Concerning Open-Enrolhnent Charter Schools 19 TAC Chapter 100 provides more specific information about commissioner action and intervention and other issues concerning open-enrolhnent charter schools

Internal reviews for aU renewal applications will be conducted by lEA staff in areas such as student performance business operations and fiscal management and compliance Components for determining adequate studentperjOf1M1lCe generally include accountability ratings AEIS indicators and other relevant student performance information as reported by the charter school on this application and as supported by required evidence and documentation

Components for evaluating business andfiscal management generally consist ofa review by the Financial Audits Division ofannual financial andits and other relevant documents

Agency compliance requirements that may be generally considered include but are not limited to timely and accurate submission ofgrant expenditures and evaluations PEIMS reports accountabilityaccreditation information (including data requested prior to on-site visits and fullow-up information sueb as corrective action plans for bilingual and special education programs and P ASlDAS risk levels) assessment requests (including requests for and submission oftesting materials) other special education infunnation governance data student transfer data required by Civil Action 5281 and the renewal appIication

Complaints made against the chatter school through the Agency complaints process may also be considered as well as any issues concerning the health safety and welfure of students

Open-EnroUment Charter School Renewal Application Generation Two - Fast-TrackAbbreviated

Part I Charter Update

Charter Holder Name Mid-Cities Learning Center Inc (ie nonprofit organization institution of higher learning or governmental entity)

Charter School Name Treetops School International

Charter School CountylDistrict 220-80 I

Campus Name(s) County~cUCampus

220-801()()1Treetops International

Section L Maximum EnroUment Grades Served and Geograpbic Boundaries In the spaces below please list the maximum enrollment the grades the charter school serves (indicating ifthere is an approved OED program) and the geographic boundaries

A Maximum Enrollment 480

B Grades Served K-12

Approved GED Program YES 0 NO 8l

c Geographic Boundaries (School Districts) 184-907 Aledo ISO 220-802 ArI Classics Acad 220-919 eanvll ISO 057-905 DaIIas ISO 220-918 EagJe Mountain Saginaw ISO 220-905 FW ISO 220-906 ColleyvilleltJrapevine ISO 220-907 Keller ISO 057middot910 Grand Prarie ISO 220middot916 HEB ISO 220middot920 White Setlemnt ISO 220-902 Birdville ISO 057middot903 Farmers Branch ISO 057-922 Coppell ISO 220-914 Crowley ISO 220middot912 Keonedale ISO 057-803 North Hills Charter 220-904 Everman ISO 220-915 Azle ISO 220-908 Mansfield ISO 220-910 Lake Worth ISO

Dr Mike Saclren

Kathy FJunan Clardy

Shelly Moyers

Coke

Meg Richter

Ray Howard

Janet McEwen

Karen Davidenko

SectiOD n Governance Structure and Procedures Review TEC Sec 12121 and 19 TAC Chapter 100 Division 5 (Charter School Governance) which lists among other things powers and duties that must be exercised by the governing body ofthe charter bolder and nepotism and conflict of interest prohibitions and exceptions

Where indicated list all relatives ofthe members ofthe Governing Body ofthe Charter Holder ofthe Governing Body ofthe Charter School and ofthe Officers ofthe Charter School within the third degree ofconsanguinity or affinity These include your spouse and the following relations to you and to your spouse parents children grandchildren siblings grandparents great-grandparents nieces nephews aunts uncles and great-grandchildren

A Goyeming Body of Charter Holder 1 In the spaces below please list the names ofthe members ofthe governing body ofthe charter bolder the offices held any board members relative within the third degree ofconsanguinity or affinity (see definition above) and any compensation or remuneration from the charter bolder or charter school received by the board members

OJ

President none none

Vice President none none

none none

Treasurer none none

At Large none none

Development none none

Public Relations none none

At none none

2 Will any relative ofthe board member within the third degree ofconsanguinity or affinity (see definition above) be employed by or receive any compensation or remuneration from the charter bolder or the charter school Ifyes provide details in the space provided below YES 0 NO 181

3 Will any boerd members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the cbarter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

4 Will any person who is a relative within the third degree ofconsanguinity or affinity (see definition on page 3) ofa charter school officer (ie a person charged with the duties of or acting as a chief executive officer a central administrator a campus administration officer or a business manager) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YESD NO[8l

B Govemi Bodv g$arter School I Ifthe governance structure includes more than one board (ie a governing body tbat is separate from the governing body ofthe charter holder) in the spaces below please list the names ofthe members ofthe governing body ofthe charter school the offices held any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) and any compensation or remuneration from the charter holder or charter school received by the board members

Board Member Ne Relative(s) Within the Third IJegne Board MemberOfJiuBeid or Couanguinity or AffiDity WOO Compensation or are Also Serting OR the Board RemJaeratiOD Per Year

2 Will any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or the charter school Ifyes provide details in space provided below YES 0 NO 121

3 Will any board members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

C Roles and Responsibilities of Governing Bodies Describe the roles and responsibilities ofboth the charter holder and charter school governing bodies Iftills represents a change from the goveroance structure currently on file with the Agency please indicate that it is a change and describe the difference from the previous structure

The Board ofDirectors is the policy making body ofTreetops International School and Mid-Cities Learning Center It is responsible for establishing the philosophy and objectives ofthe school for the effective implementation ofthese policies their review and evalnation in accordance with TEA requirements No change of duties

D Qamplzational ~hn Crimioll Historv Records BiotranlilaI Affillam bull Submit an organirntional chart Include this document as AttacbmeDt 1 Organizational Chart bull Submit a criminal history record for each board member Include these documents as AttacbmeDt 2 Criminal

History Records for Board Members bull Submit a biographical affidavit for each board member Include these documents as Attachment 3 Board

Member Biographical Affidavit

Section m Teacher QualifICations In the space provided describe the qualifications required for all classroom teachers and other instructional staff Ifthis represents a change from the charter application on file with the Agency or approved amendments please indicate that it is a change and describe the difference from the previous requirement

In with teacher are met with all having a high school Currently all teachers (25) are degreed 8 have masters one is completing her PhD and one has PhD It has been the standard to have a college degree to teach Treetops does not currently receive Title I funds but will insure that in the future all teachers in core areas are college graduates

Section IV Code ofCondurt In the space provided describe the methods used to inform parents and students about school rules and guidelines governing student behavior Include policies regarding student expulsion and suspension and procedures that satisfY due process requirements

posted on page are enrollment as well as distributed at the parent meeting or two days before school opens a copy is also in the office for public review This handbook covers policies on student attendance discipline and general operating guidelines ofthe school Ifthere is a need for discipline the parent is contacted by phone reguaIr mail and certified mail All discipline actions including student suspensions and expulsions are elligible for appeal to the school board but the decision ofthe Board is binding

Section V Complaints In the space provided descnbe the methods used to inform parents students and employees about the procedures for receiving and responding to complaints (Note Under 19 TAC sect 100 II0 l(e) the governing body ofa charter holder shall not delegate final authority to hear or decide employee grievances citizen complaints or parental concerns)

Parents and students a student during the open meeting 2 days prior to explains a grievance The policy is also on the web page (wwwtreetopsotg) is posted in the adtnirutration office and on the buIIetine board in the high school building Employees receive an employee handbook and attend inservice concerning procedures for filing a grievance The grievance policy is I) contact in writing the person grievance is with for a meeting 2) Ifnot resolved submit in writing to the Board ofDiredors the grievance 3) The Board will appoint a grievance conunittee formed ofone Board member a faculty member and a parent to review all written statements and interview all parties 4) Majority decisions by the Board are binding TEA continues to keep a record ofall complaints against Treetops and as complaints are released they are addressed by the school policy

Section VL Admissions PoHey In the space provided describe the time1ine used for admitting students including the application deadline and the process for the admission of students by lottery (Although state law permits students to be accepted on a first come first served basis or through a lottery a charter schoo) that is oversubscribed must use a lottery to be eliaible to receive federal funds)

to TreetoPs is based on being an open enrollment school that uses the lottery system All policies and paperwork has the anti-discrimination statement as required by the TEC (12111) as well as being posted in the office and on the school web page The appliauion period for exempt (returning) students is from Manh 1 through March 28 For new applicants registration will be held from March 29 to April 30 Once the openings have been filled students whose names are not drawn are placed on a waiting list A lottery drawing will be held on March 29 Parents must complete the frist page ofthe enrollment form and provide copies ofsocial security card birth certificate and a copy of shot records before the enrollment may be complete The 2002-2003 enrollment forms may be downloaded and printed Admissions will not be based on gender national orgin ethnicity religion disability academic artistic athletic ability or the district the student would otherwise attend

Section VB Student Performance Goals In the spaces provided below identify the schools academic goals for student learning for the next five years in terms of AEIS base and additional indicators and other relevant performance information

Some accountability standards and criteria for 2004 and 2005 are available in the 2002 ACCOWIIability Manual which is available at TAKS passing standards for Exemplary and Recognized are the same as in 2002 Rating criteria and standards have not yet been determined beyond 2002 for completion rate dropout rate the State-Developed Alternative Assessment (SDAA) and the Academically Acceptable Acceptable rating

A AEIS Base Indicators Describe student performance goals in terms ofAEIS base indicators (ie T AAS scores and dropout rates) Be specific about indicators such as percentage ofstudents passing exams and annual dropout rates Note Campuses rated under the Alternative Education Accountability system may also have student attendance and Texas Learning Inder (lU) growth as base indicators

an years to scores to a level Tutorials are offered at all grade levels in an effort to improve performance scores and ratings There has been significant improvemeot in progress ofprior year TAAS fuilers as reflected in the average TLI Growth reading 2001 1357 as opposed to 750 in 2000 reading 429 to 2000 333 and math improving from 300 to 318 All passing tests went from 2000s score of532 to 583 Annual drop out rate continues to be low (08) and attendance rate continues to be in the 95th percentile AP test rates are 161 from 148 previous year There is a strong movement to offer more AP courses and to improve the reading level ofall students TreetoPs showed a 852 passing reading 574 passing writing and 654 passing math Math continues to show improvement but is the weak spot and is being addressed with change ofpersonnel and totorials Summer school is being offered at no clwge in math to help stmegthen skills our exemptions were below the state average at 06 Campus TLI average growth reflects 832 Out of 14 graduates this year 12 are college bound one is technical school bound and one joined the Air Force

B AEIS Additional Indicators Describe student performance goals in terms ofAEIS additional indicators (ie attendance rates 4-year completion rate college admissions testing and participation in the recommended high school program) Be specific about indicators such as average Texas Learning Index (TLl) growth year-to-year progress and accountability ratings NoteCampuses rated under the Alternative Education Accountability system may also have campus-selected additional indicators

rate was the school year with an annual drop out rate in comparison state average of 13 Every grader takes the PSAT and the PLAN tests at school in an effort to be prepared for the SAT and the ACT The 2001 avg TLI was 7536 and growth from 6704 the previous year

c Othu Relevant Perfonnnce Goas Describe other relevant student performance goals that may be unique to your school

are and enhance their the are offered daily in the morning and afternoons It has become a challenge to raise the of learning for each student that is being met head 011 Learning in cInsters has made a significant difference for our students as they mentor each other and make learning accessible to all Mentoring younger students has not only prepared the mentors in academic learning but also in life skills Comuunity service projects have been used as incentives to learn how to make use ofthe skills obtained in the classroom Community service projects are performed at aJ levels across the campus The TAKS will be readily understood by being prepared with practical examples It is our goal to bring the aCceptable rating to recognized this next year

Section vm Monitoring FoIlowUp Discuss improvements made and other actions taken to address any and aJ findings recommendations or sanctions by TEA including those resulting from monitoring on-site visits or hearings Provide specific information about compliance status with aJ special program indicators including corrective action plans for bilingual and special education programs and about PASIDAS risk levels

In compliance with the DEC review and the CAR visit there have beeu mauy changes at Treetops in splaquoia1 education bilingual and accounting procedures In April aU personnel connected to the adminstration was replaced Currently Region XI handles aU fmancial records pays all bills and issues all checks A fmancial system has been implemented where the hills are coded at the district sent to Region XI for review and checks are cut they are returned to the district for siguature and mailings Region XI is processing payroH PEIMS TRS deposits and health insurance In the 2001-2002 school year Region XI will also he handling aU attendance reporting The audits have beeu late due to previous accounting procedures and previous adminstrations which have aU changed as of April 2001 Bank reconciliations are current accounting reports are current credit cards are no longer being used the budget is in compliance with proper coding penonnel files are complete and documentation is kept in accordance to TEA and standard accounting procedure The CAR has generated ESL training for employees the hiring of two ESL teachers and the implementation ofa bilingual program even though Treetops cnrrently has no ESL students LPAC traioiug has been completed by three stafl memben and LEP procedures including the handbook have been implemented Special education reviews showed that we were laeking in documentation in previous yean Ardia Kentfield a Texas certified diagusotician was hired and has completed bringing aU the forms and files up to state requirements Inserviee was held on Dec 10 for assistive technology as weD as diseussion concerning the CAR visit and compliance The last ofthe doeumentation was seat to Austin on May 30 2001 to com~lete the follow u~visit ~

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 4: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

General Scope ofAgency Review

As authorized in Texas Education Code sect 12115 the commissioner may modify place on probation revoke or deny renewal ofthe charter ofan open-enrolhnent chatter school iftbe commissioner determines that the charter holder

I) conunitted a material violation of the charter including fiIilure to satisfY accountability provisions prescribed by the charter

2) fiIiled to satisfy generally accepted accounting standards offiscal management 3) fiIiled to protect the health safety or weIWe ofthe students enrolled at the school or 4) fiIiled to comply with this subchapter or another applicable law or rule

The Commissioners Rules Concerning Open-Enrolhnent Charter Schools 19 TAC Chapter 100 provides more specific information about commissioner action and intervention and other issues concerning open-enrolhnent charter schools

Internal reviews for aU renewal applications will be conducted by lEA staff in areas such as student performance business operations and fiscal management and compliance Components for determining adequate studentperjOf1M1lCe generally include accountability ratings AEIS indicators and other relevant student performance information as reported by the charter school on this application and as supported by required evidence and documentation

Components for evaluating business andfiscal management generally consist ofa review by the Financial Audits Division ofannual financial andits and other relevant documents

Agency compliance requirements that may be generally considered include but are not limited to timely and accurate submission ofgrant expenditures and evaluations PEIMS reports accountabilityaccreditation information (including data requested prior to on-site visits and fullow-up information sueb as corrective action plans for bilingual and special education programs and P ASlDAS risk levels) assessment requests (including requests for and submission oftesting materials) other special education infunnation governance data student transfer data required by Civil Action 5281 and the renewal appIication

Complaints made against the chatter school through the Agency complaints process may also be considered as well as any issues concerning the health safety and welfure of students

Open-EnroUment Charter School Renewal Application Generation Two - Fast-TrackAbbreviated

Part I Charter Update

Charter Holder Name Mid-Cities Learning Center Inc (ie nonprofit organization institution of higher learning or governmental entity)

Charter School Name Treetops School International

Charter School CountylDistrict 220-80 I

Campus Name(s) County~cUCampus

220-801()()1Treetops International

Section L Maximum EnroUment Grades Served and Geograpbic Boundaries In the spaces below please list the maximum enrollment the grades the charter school serves (indicating ifthere is an approved OED program) and the geographic boundaries

A Maximum Enrollment 480

B Grades Served K-12

Approved GED Program YES 0 NO 8l

c Geographic Boundaries (School Districts) 184-907 Aledo ISO 220-802 ArI Classics Acad 220-919 eanvll ISO 057-905 DaIIas ISO 220-918 EagJe Mountain Saginaw ISO 220-905 FW ISO 220-906 ColleyvilleltJrapevine ISO 220-907 Keller ISO 057middot910 Grand Prarie ISO 220middot916 HEB ISO 220middot920 White Setlemnt ISO 220-902 Birdville ISO 057middot903 Farmers Branch ISO 057-922 Coppell ISO 220-914 Crowley ISO 220middot912 Keonedale ISO 057-803 North Hills Charter 220-904 Everman ISO 220-915 Azle ISO 220-908 Mansfield ISO 220-910 Lake Worth ISO

Dr Mike Saclren

Kathy FJunan Clardy

Shelly Moyers

Coke

Meg Richter

Ray Howard

Janet McEwen

Karen Davidenko

SectiOD n Governance Structure and Procedures Review TEC Sec 12121 and 19 TAC Chapter 100 Division 5 (Charter School Governance) which lists among other things powers and duties that must be exercised by the governing body ofthe charter bolder and nepotism and conflict of interest prohibitions and exceptions

Where indicated list all relatives ofthe members ofthe Governing Body ofthe Charter Holder ofthe Governing Body ofthe Charter School and ofthe Officers ofthe Charter School within the third degree ofconsanguinity or affinity These include your spouse and the following relations to you and to your spouse parents children grandchildren siblings grandparents great-grandparents nieces nephews aunts uncles and great-grandchildren

A Goyeming Body of Charter Holder 1 In the spaces below please list the names ofthe members ofthe governing body ofthe charter bolder the offices held any board members relative within the third degree ofconsanguinity or affinity (see definition above) and any compensation or remuneration from the charter bolder or charter school received by the board members

OJ

President none none

Vice President none none

none none

Treasurer none none

At Large none none

Development none none

Public Relations none none

At none none

2 Will any relative ofthe board member within the third degree ofconsanguinity or affinity (see definition above) be employed by or receive any compensation or remuneration from the charter bolder or the charter school Ifyes provide details in the space provided below YES 0 NO 181

3 Will any boerd members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the cbarter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

4 Will any person who is a relative within the third degree ofconsanguinity or affinity (see definition on page 3) ofa charter school officer (ie a person charged with the duties of or acting as a chief executive officer a central administrator a campus administration officer or a business manager) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YESD NO[8l

B Govemi Bodv g$arter School I Ifthe governance structure includes more than one board (ie a governing body tbat is separate from the governing body ofthe charter holder) in the spaces below please list the names ofthe members ofthe governing body ofthe charter school the offices held any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) and any compensation or remuneration from the charter holder or charter school received by the board members

Board Member Ne Relative(s) Within the Third IJegne Board MemberOfJiuBeid or Couanguinity or AffiDity WOO Compensation or are Also Serting OR the Board RemJaeratiOD Per Year

2 Will any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or the charter school Ifyes provide details in space provided below YES 0 NO 121

3 Will any board members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

C Roles and Responsibilities of Governing Bodies Describe the roles and responsibilities ofboth the charter holder and charter school governing bodies Iftills represents a change from the goveroance structure currently on file with the Agency please indicate that it is a change and describe the difference from the previous structure

The Board ofDirectors is the policy making body ofTreetops International School and Mid-Cities Learning Center It is responsible for establishing the philosophy and objectives ofthe school for the effective implementation ofthese policies their review and evalnation in accordance with TEA requirements No change of duties

D Qamplzational ~hn Crimioll Historv Records BiotranlilaI Affillam bull Submit an organirntional chart Include this document as AttacbmeDt 1 Organizational Chart bull Submit a criminal history record for each board member Include these documents as AttacbmeDt 2 Criminal

History Records for Board Members bull Submit a biographical affidavit for each board member Include these documents as Attachment 3 Board

Member Biographical Affidavit

Section m Teacher QualifICations In the space provided describe the qualifications required for all classroom teachers and other instructional staff Ifthis represents a change from the charter application on file with the Agency or approved amendments please indicate that it is a change and describe the difference from the previous requirement

In with teacher are met with all having a high school Currently all teachers (25) are degreed 8 have masters one is completing her PhD and one has PhD It has been the standard to have a college degree to teach Treetops does not currently receive Title I funds but will insure that in the future all teachers in core areas are college graduates

Section IV Code ofCondurt In the space provided describe the methods used to inform parents and students about school rules and guidelines governing student behavior Include policies regarding student expulsion and suspension and procedures that satisfY due process requirements

posted on page are enrollment as well as distributed at the parent meeting or two days before school opens a copy is also in the office for public review This handbook covers policies on student attendance discipline and general operating guidelines ofthe school Ifthere is a need for discipline the parent is contacted by phone reguaIr mail and certified mail All discipline actions including student suspensions and expulsions are elligible for appeal to the school board but the decision ofthe Board is binding

Section V Complaints In the space provided descnbe the methods used to inform parents students and employees about the procedures for receiving and responding to complaints (Note Under 19 TAC sect 100 II0 l(e) the governing body ofa charter holder shall not delegate final authority to hear or decide employee grievances citizen complaints or parental concerns)

Parents and students a student during the open meeting 2 days prior to explains a grievance The policy is also on the web page (wwwtreetopsotg) is posted in the adtnirutration office and on the buIIetine board in the high school building Employees receive an employee handbook and attend inservice concerning procedures for filing a grievance The grievance policy is I) contact in writing the person grievance is with for a meeting 2) Ifnot resolved submit in writing to the Board ofDiredors the grievance 3) The Board will appoint a grievance conunittee formed ofone Board member a faculty member and a parent to review all written statements and interview all parties 4) Majority decisions by the Board are binding TEA continues to keep a record ofall complaints against Treetops and as complaints are released they are addressed by the school policy

Section VL Admissions PoHey In the space provided describe the time1ine used for admitting students including the application deadline and the process for the admission of students by lottery (Although state law permits students to be accepted on a first come first served basis or through a lottery a charter schoo) that is oversubscribed must use a lottery to be eliaible to receive federal funds)

to TreetoPs is based on being an open enrollment school that uses the lottery system All policies and paperwork has the anti-discrimination statement as required by the TEC (12111) as well as being posted in the office and on the school web page The appliauion period for exempt (returning) students is from Manh 1 through March 28 For new applicants registration will be held from March 29 to April 30 Once the openings have been filled students whose names are not drawn are placed on a waiting list A lottery drawing will be held on March 29 Parents must complete the frist page ofthe enrollment form and provide copies ofsocial security card birth certificate and a copy of shot records before the enrollment may be complete The 2002-2003 enrollment forms may be downloaded and printed Admissions will not be based on gender national orgin ethnicity religion disability academic artistic athletic ability or the district the student would otherwise attend

Section VB Student Performance Goals In the spaces provided below identify the schools academic goals for student learning for the next five years in terms of AEIS base and additional indicators and other relevant performance information

Some accountability standards and criteria for 2004 and 2005 are available in the 2002 ACCOWIIability Manual which is available at TAKS passing standards for Exemplary and Recognized are the same as in 2002 Rating criteria and standards have not yet been determined beyond 2002 for completion rate dropout rate the State-Developed Alternative Assessment (SDAA) and the Academically Acceptable Acceptable rating

A AEIS Base Indicators Describe student performance goals in terms ofAEIS base indicators (ie T AAS scores and dropout rates) Be specific about indicators such as percentage ofstudents passing exams and annual dropout rates Note Campuses rated under the Alternative Education Accountability system may also have student attendance and Texas Learning Inder (lU) growth as base indicators

an years to scores to a level Tutorials are offered at all grade levels in an effort to improve performance scores and ratings There has been significant improvemeot in progress ofprior year TAAS fuilers as reflected in the average TLI Growth reading 2001 1357 as opposed to 750 in 2000 reading 429 to 2000 333 and math improving from 300 to 318 All passing tests went from 2000s score of532 to 583 Annual drop out rate continues to be low (08) and attendance rate continues to be in the 95th percentile AP test rates are 161 from 148 previous year There is a strong movement to offer more AP courses and to improve the reading level ofall students TreetoPs showed a 852 passing reading 574 passing writing and 654 passing math Math continues to show improvement but is the weak spot and is being addressed with change ofpersonnel and totorials Summer school is being offered at no clwge in math to help stmegthen skills our exemptions were below the state average at 06 Campus TLI average growth reflects 832 Out of 14 graduates this year 12 are college bound one is technical school bound and one joined the Air Force

B AEIS Additional Indicators Describe student performance goals in terms ofAEIS additional indicators (ie attendance rates 4-year completion rate college admissions testing and participation in the recommended high school program) Be specific about indicators such as average Texas Learning Index (TLl) growth year-to-year progress and accountability ratings NoteCampuses rated under the Alternative Education Accountability system may also have campus-selected additional indicators

rate was the school year with an annual drop out rate in comparison state average of 13 Every grader takes the PSAT and the PLAN tests at school in an effort to be prepared for the SAT and the ACT The 2001 avg TLI was 7536 and growth from 6704 the previous year

c Othu Relevant Perfonnnce Goas Describe other relevant student performance goals that may be unique to your school

are and enhance their the are offered daily in the morning and afternoons It has become a challenge to raise the of learning for each student that is being met head 011 Learning in cInsters has made a significant difference for our students as they mentor each other and make learning accessible to all Mentoring younger students has not only prepared the mentors in academic learning but also in life skills Comuunity service projects have been used as incentives to learn how to make use ofthe skills obtained in the classroom Community service projects are performed at aJ levels across the campus The TAKS will be readily understood by being prepared with practical examples It is our goal to bring the aCceptable rating to recognized this next year

Section vm Monitoring FoIlowUp Discuss improvements made and other actions taken to address any and aJ findings recommendations or sanctions by TEA including those resulting from monitoring on-site visits or hearings Provide specific information about compliance status with aJ special program indicators including corrective action plans for bilingual and special education programs and about PASIDAS risk levels

In compliance with the DEC review and the CAR visit there have beeu mauy changes at Treetops in splaquoia1 education bilingual and accounting procedures In April aU personnel connected to the adminstration was replaced Currently Region XI handles aU fmancial records pays all bills and issues all checks A fmancial system has been implemented where the hills are coded at the district sent to Region XI for review and checks are cut they are returned to the district for siguature and mailings Region XI is processing payroH PEIMS TRS deposits and health insurance In the 2001-2002 school year Region XI will also he handling aU attendance reporting The audits have beeu late due to previous accounting procedures and previous adminstrations which have aU changed as of April 2001 Bank reconciliations are current accounting reports are current credit cards are no longer being used the budget is in compliance with proper coding penonnel files are complete and documentation is kept in accordance to TEA and standard accounting procedure The CAR has generated ESL training for employees the hiring of two ESL teachers and the implementation ofa bilingual program even though Treetops cnrrently has no ESL students LPAC traioiug has been completed by three stafl memben and LEP procedures including the handbook have been implemented Special education reviews showed that we were laeking in documentation in previous yean Ardia Kentfield a Texas certified diagusotician was hired and has completed bringing aU the forms and files up to state requirements Inserviee was held on Dec 10 for assistive technology as weD as diseussion concerning the CAR visit and compliance The last ofthe doeumentation was seat to Austin on May 30 2001 to com~lete the follow u~visit ~

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 5: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Open-EnroUment Charter School Renewal Application Generation Two - Fast-TrackAbbreviated

Part I Charter Update

Charter Holder Name Mid-Cities Learning Center Inc (ie nonprofit organization institution of higher learning or governmental entity)

Charter School Name Treetops School International

Charter School CountylDistrict 220-80 I

Campus Name(s) County~cUCampus

220-801()()1Treetops International

Section L Maximum EnroUment Grades Served and Geograpbic Boundaries In the spaces below please list the maximum enrollment the grades the charter school serves (indicating ifthere is an approved OED program) and the geographic boundaries

A Maximum Enrollment 480

B Grades Served K-12

Approved GED Program YES 0 NO 8l

c Geographic Boundaries (School Districts) 184-907 Aledo ISO 220-802 ArI Classics Acad 220-919 eanvll ISO 057-905 DaIIas ISO 220-918 EagJe Mountain Saginaw ISO 220-905 FW ISO 220-906 ColleyvilleltJrapevine ISO 220-907 Keller ISO 057middot910 Grand Prarie ISO 220middot916 HEB ISO 220middot920 White Setlemnt ISO 220-902 Birdville ISO 057middot903 Farmers Branch ISO 057-922 Coppell ISO 220-914 Crowley ISO 220middot912 Keonedale ISO 057-803 North Hills Charter 220-904 Everman ISO 220-915 Azle ISO 220-908 Mansfield ISO 220-910 Lake Worth ISO

Dr Mike Saclren

Kathy FJunan Clardy

Shelly Moyers

Coke

Meg Richter

Ray Howard

Janet McEwen

Karen Davidenko

SectiOD n Governance Structure and Procedures Review TEC Sec 12121 and 19 TAC Chapter 100 Division 5 (Charter School Governance) which lists among other things powers and duties that must be exercised by the governing body ofthe charter bolder and nepotism and conflict of interest prohibitions and exceptions

Where indicated list all relatives ofthe members ofthe Governing Body ofthe Charter Holder ofthe Governing Body ofthe Charter School and ofthe Officers ofthe Charter School within the third degree ofconsanguinity or affinity These include your spouse and the following relations to you and to your spouse parents children grandchildren siblings grandparents great-grandparents nieces nephews aunts uncles and great-grandchildren

A Goyeming Body of Charter Holder 1 In the spaces below please list the names ofthe members ofthe governing body ofthe charter bolder the offices held any board members relative within the third degree ofconsanguinity or affinity (see definition above) and any compensation or remuneration from the charter bolder or charter school received by the board members

OJ

President none none

Vice President none none

none none

Treasurer none none

At Large none none

Development none none

Public Relations none none

At none none

2 Will any relative ofthe board member within the third degree ofconsanguinity or affinity (see definition above) be employed by or receive any compensation or remuneration from the charter bolder or the charter school Ifyes provide details in the space provided below YES 0 NO 181

3 Will any boerd members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the cbarter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

4 Will any person who is a relative within the third degree ofconsanguinity or affinity (see definition on page 3) ofa charter school officer (ie a person charged with the duties of or acting as a chief executive officer a central administrator a campus administration officer or a business manager) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YESD NO[8l

B Govemi Bodv g$arter School I Ifthe governance structure includes more than one board (ie a governing body tbat is separate from the governing body ofthe charter holder) in the spaces below please list the names ofthe members ofthe governing body ofthe charter school the offices held any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) and any compensation or remuneration from the charter holder or charter school received by the board members

Board Member Ne Relative(s) Within the Third IJegne Board MemberOfJiuBeid or Couanguinity or AffiDity WOO Compensation or are Also Serting OR the Board RemJaeratiOD Per Year

2 Will any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or the charter school Ifyes provide details in space provided below YES 0 NO 121

3 Will any board members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

C Roles and Responsibilities of Governing Bodies Describe the roles and responsibilities ofboth the charter holder and charter school governing bodies Iftills represents a change from the goveroance structure currently on file with the Agency please indicate that it is a change and describe the difference from the previous structure

The Board ofDirectors is the policy making body ofTreetops International School and Mid-Cities Learning Center It is responsible for establishing the philosophy and objectives ofthe school for the effective implementation ofthese policies their review and evalnation in accordance with TEA requirements No change of duties

D Qamplzational ~hn Crimioll Historv Records BiotranlilaI Affillam bull Submit an organirntional chart Include this document as AttacbmeDt 1 Organizational Chart bull Submit a criminal history record for each board member Include these documents as AttacbmeDt 2 Criminal

History Records for Board Members bull Submit a biographical affidavit for each board member Include these documents as Attachment 3 Board

Member Biographical Affidavit

Section m Teacher QualifICations In the space provided describe the qualifications required for all classroom teachers and other instructional staff Ifthis represents a change from the charter application on file with the Agency or approved amendments please indicate that it is a change and describe the difference from the previous requirement

In with teacher are met with all having a high school Currently all teachers (25) are degreed 8 have masters one is completing her PhD and one has PhD It has been the standard to have a college degree to teach Treetops does not currently receive Title I funds but will insure that in the future all teachers in core areas are college graduates

Section IV Code ofCondurt In the space provided describe the methods used to inform parents and students about school rules and guidelines governing student behavior Include policies regarding student expulsion and suspension and procedures that satisfY due process requirements

posted on page are enrollment as well as distributed at the parent meeting or two days before school opens a copy is also in the office for public review This handbook covers policies on student attendance discipline and general operating guidelines ofthe school Ifthere is a need for discipline the parent is contacted by phone reguaIr mail and certified mail All discipline actions including student suspensions and expulsions are elligible for appeal to the school board but the decision ofthe Board is binding

Section V Complaints In the space provided descnbe the methods used to inform parents students and employees about the procedures for receiving and responding to complaints (Note Under 19 TAC sect 100 II0 l(e) the governing body ofa charter holder shall not delegate final authority to hear or decide employee grievances citizen complaints or parental concerns)

Parents and students a student during the open meeting 2 days prior to explains a grievance The policy is also on the web page (wwwtreetopsotg) is posted in the adtnirutration office and on the buIIetine board in the high school building Employees receive an employee handbook and attend inservice concerning procedures for filing a grievance The grievance policy is I) contact in writing the person grievance is with for a meeting 2) Ifnot resolved submit in writing to the Board ofDiredors the grievance 3) The Board will appoint a grievance conunittee formed ofone Board member a faculty member and a parent to review all written statements and interview all parties 4) Majority decisions by the Board are binding TEA continues to keep a record ofall complaints against Treetops and as complaints are released they are addressed by the school policy

Section VL Admissions PoHey In the space provided describe the time1ine used for admitting students including the application deadline and the process for the admission of students by lottery (Although state law permits students to be accepted on a first come first served basis or through a lottery a charter schoo) that is oversubscribed must use a lottery to be eliaible to receive federal funds)

to TreetoPs is based on being an open enrollment school that uses the lottery system All policies and paperwork has the anti-discrimination statement as required by the TEC (12111) as well as being posted in the office and on the school web page The appliauion period for exempt (returning) students is from Manh 1 through March 28 For new applicants registration will be held from March 29 to April 30 Once the openings have been filled students whose names are not drawn are placed on a waiting list A lottery drawing will be held on March 29 Parents must complete the frist page ofthe enrollment form and provide copies ofsocial security card birth certificate and a copy of shot records before the enrollment may be complete The 2002-2003 enrollment forms may be downloaded and printed Admissions will not be based on gender national orgin ethnicity religion disability academic artistic athletic ability or the district the student would otherwise attend

Section VB Student Performance Goals In the spaces provided below identify the schools academic goals for student learning for the next five years in terms of AEIS base and additional indicators and other relevant performance information

Some accountability standards and criteria for 2004 and 2005 are available in the 2002 ACCOWIIability Manual which is available at TAKS passing standards for Exemplary and Recognized are the same as in 2002 Rating criteria and standards have not yet been determined beyond 2002 for completion rate dropout rate the State-Developed Alternative Assessment (SDAA) and the Academically Acceptable Acceptable rating

A AEIS Base Indicators Describe student performance goals in terms ofAEIS base indicators (ie T AAS scores and dropout rates) Be specific about indicators such as percentage ofstudents passing exams and annual dropout rates Note Campuses rated under the Alternative Education Accountability system may also have student attendance and Texas Learning Inder (lU) growth as base indicators

an years to scores to a level Tutorials are offered at all grade levels in an effort to improve performance scores and ratings There has been significant improvemeot in progress ofprior year TAAS fuilers as reflected in the average TLI Growth reading 2001 1357 as opposed to 750 in 2000 reading 429 to 2000 333 and math improving from 300 to 318 All passing tests went from 2000s score of532 to 583 Annual drop out rate continues to be low (08) and attendance rate continues to be in the 95th percentile AP test rates are 161 from 148 previous year There is a strong movement to offer more AP courses and to improve the reading level ofall students TreetoPs showed a 852 passing reading 574 passing writing and 654 passing math Math continues to show improvement but is the weak spot and is being addressed with change ofpersonnel and totorials Summer school is being offered at no clwge in math to help stmegthen skills our exemptions were below the state average at 06 Campus TLI average growth reflects 832 Out of 14 graduates this year 12 are college bound one is technical school bound and one joined the Air Force

B AEIS Additional Indicators Describe student performance goals in terms ofAEIS additional indicators (ie attendance rates 4-year completion rate college admissions testing and participation in the recommended high school program) Be specific about indicators such as average Texas Learning Index (TLl) growth year-to-year progress and accountability ratings NoteCampuses rated under the Alternative Education Accountability system may also have campus-selected additional indicators

rate was the school year with an annual drop out rate in comparison state average of 13 Every grader takes the PSAT and the PLAN tests at school in an effort to be prepared for the SAT and the ACT The 2001 avg TLI was 7536 and growth from 6704 the previous year

c Othu Relevant Perfonnnce Goas Describe other relevant student performance goals that may be unique to your school

are and enhance their the are offered daily in the morning and afternoons It has become a challenge to raise the of learning for each student that is being met head 011 Learning in cInsters has made a significant difference for our students as they mentor each other and make learning accessible to all Mentoring younger students has not only prepared the mentors in academic learning but also in life skills Comuunity service projects have been used as incentives to learn how to make use ofthe skills obtained in the classroom Community service projects are performed at aJ levels across the campus The TAKS will be readily understood by being prepared with practical examples It is our goal to bring the aCceptable rating to recognized this next year

Section vm Monitoring FoIlowUp Discuss improvements made and other actions taken to address any and aJ findings recommendations or sanctions by TEA including those resulting from monitoring on-site visits or hearings Provide specific information about compliance status with aJ special program indicators including corrective action plans for bilingual and special education programs and about PASIDAS risk levels

In compliance with the DEC review and the CAR visit there have beeu mauy changes at Treetops in splaquoia1 education bilingual and accounting procedures In April aU personnel connected to the adminstration was replaced Currently Region XI handles aU fmancial records pays all bills and issues all checks A fmancial system has been implemented where the hills are coded at the district sent to Region XI for review and checks are cut they are returned to the district for siguature and mailings Region XI is processing payroH PEIMS TRS deposits and health insurance In the 2001-2002 school year Region XI will also he handling aU attendance reporting The audits have beeu late due to previous accounting procedures and previous adminstrations which have aU changed as of April 2001 Bank reconciliations are current accounting reports are current credit cards are no longer being used the budget is in compliance with proper coding penonnel files are complete and documentation is kept in accordance to TEA and standard accounting procedure The CAR has generated ESL training for employees the hiring of two ESL teachers and the implementation ofa bilingual program even though Treetops cnrrently has no ESL students LPAC traioiug has been completed by three stafl memben and LEP procedures including the handbook have been implemented Special education reviews showed that we were laeking in documentation in previous yean Ardia Kentfield a Texas certified diagusotician was hired and has completed bringing aU the forms and files up to state requirements Inserviee was held on Dec 10 for assistive technology as weD as diseussion concerning the CAR visit and compliance The last ofthe doeumentation was seat to Austin on May 30 2001 to com~lete the follow u~visit ~

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 6: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

A Maximum Enrollment 480

B Grades Served K-12

Approved GED Program YES 0 NO 8l

c Geographic Boundaries (School Districts) 184-907 Aledo ISO 220-802 ArI Classics Acad 220-919 eanvll ISO 057-905 DaIIas ISO 220-918 EagJe Mountain Saginaw ISO 220-905 FW ISO 220-906 ColleyvilleltJrapevine ISO 220-907 Keller ISO 057middot910 Grand Prarie ISO 220middot916 HEB ISO 220middot920 White Setlemnt ISO 220-902 Birdville ISO 057middot903 Farmers Branch ISO 057-922 Coppell ISO 220-914 Crowley ISO 220middot912 Keonedale ISO 057-803 North Hills Charter 220-904 Everman ISO 220-915 Azle ISO 220-908 Mansfield ISO 220-910 Lake Worth ISO

Dr Mike Saclren

Kathy FJunan Clardy

Shelly Moyers

Coke

Meg Richter

Ray Howard

Janet McEwen

Karen Davidenko

SectiOD n Governance Structure and Procedures Review TEC Sec 12121 and 19 TAC Chapter 100 Division 5 (Charter School Governance) which lists among other things powers and duties that must be exercised by the governing body ofthe charter bolder and nepotism and conflict of interest prohibitions and exceptions

Where indicated list all relatives ofthe members ofthe Governing Body ofthe Charter Holder ofthe Governing Body ofthe Charter School and ofthe Officers ofthe Charter School within the third degree ofconsanguinity or affinity These include your spouse and the following relations to you and to your spouse parents children grandchildren siblings grandparents great-grandparents nieces nephews aunts uncles and great-grandchildren

A Goyeming Body of Charter Holder 1 In the spaces below please list the names ofthe members ofthe governing body ofthe charter bolder the offices held any board members relative within the third degree ofconsanguinity or affinity (see definition above) and any compensation or remuneration from the charter bolder or charter school received by the board members

OJ

President none none

Vice President none none

none none

Treasurer none none

At Large none none

Development none none

Public Relations none none

At none none

2 Will any relative ofthe board member within the third degree ofconsanguinity or affinity (see definition above) be employed by or receive any compensation or remuneration from the charter bolder or the charter school Ifyes provide details in the space provided below YES 0 NO 181

3 Will any boerd members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the cbarter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

4 Will any person who is a relative within the third degree ofconsanguinity or affinity (see definition on page 3) ofa charter school officer (ie a person charged with the duties of or acting as a chief executive officer a central administrator a campus administration officer or a business manager) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YESD NO[8l

B Govemi Bodv g$arter School I Ifthe governance structure includes more than one board (ie a governing body tbat is separate from the governing body ofthe charter holder) in the spaces below please list the names ofthe members ofthe governing body ofthe charter school the offices held any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) and any compensation or remuneration from the charter holder or charter school received by the board members

Board Member Ne Relative(s) Within the Third IJegne Board MemberOfJiuBeid or Couanguinity or AffiDity WOO Compensation or are Also Serting OR the Board RemJaeratiOD Per Year

2 Will any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or the charter school Ifyes provide details in space provided below YES 0 NO 121

3 Will any board members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

C Roles and Responsibilities of Governing Bodies Describe the roles and responsibilities ofboth the charter holder and charter school governing bodies Iftills represents a change from the goveroance structure currently on file with the Agency please indicate that it is a change and describe the difference from the previous structure

The Board ofDirectors is the policy making body ofTreetops International School and Mid-Cities Learning Center It is responsible for establishing the philosophy and objectives ofthe school for the effective implementation ofthese policies their review and evalnation in accordance with TEA requirements No change of duties

D Qamplzational ~hn Crimioll Historv Records BiotranlilaI Affillam bull Submit an organirntional chart Include this document as AttacbmeDt 1 Organizational Chart bull Submit a criminal history record for each board member Include these documents as AttacbmeDt 2 Criminal

History Records for Board Members bull Submit a biographical affidavit for each board member Include these documents as Attachment 3 Board

Member Biographical Affidavit

Section m Teacher QualifICations In the space provided describe the qualifications required for all classroom teachers and other instructional staff Ifthis represents a change from the charter application on file with the Agency or approved amendments please indicate that it is a change and describe the difference from the previous requirement

In with teacher are met with all having a high school Currently all teachers (25) are degreed 8 have masters one is completing her PhD and one has PhD It has been the standard to have a college degree to teach Treetops does not currently receive Title I funds but will insure that in the future all teachers in core areas are college graduates

Section IV Code ofCondurt In the space provided describe the methods used to inform parents and students about school rules and guidelines governing student behavior Include policies regarding student expulsion and suspension and procedures that satisfY due process requirements

posted on page are enrollment as well as distributed at the parent meeting or two days before school opens a copy is also in the office for public review This handbook covers policies on student attendance discipline and general operating guidelines ofthe school Ifthere is a need for discipline the parent is contacted by phone reguaIr mail and certified mail All discipline actions including student suspensions and expulsions are elligible for appeal to the school board but the decision ofthe Board is binding

Section V Complaints In the space provided descnbe the methods used to inform parents students and employees about the procedures for receiving and responding to complaints (Note Under 19 TAC sect 100 II0 l(e) the governing body ofa charter holder shall not delegate final authority to hear or decide employee grievances citizen complaints or parental concerns)

Parents and students a student during the open meeting 2 days prior to explains a grievance The policy is also on the web page (wwwtreetopsotg) is posted in the adtnirutration office and on the buIIetine board in the high school building Employees receive an employee handbook and attend inservice concerning procedures for filing a grievance The grievance policy is I) contact in writing the person grievance is with for a meeting 2) Ifnot resolved submit in writing to the Board ofDiredors the grievance 3) The Board will appoint a grievance conunittee formed ofone Board member a faculty member and a parent to review all written statements and interview all parties 4) Majority decisions by the Board are binding TEA continues to keep a record ofall complaints against Treetops and as complaints are released they are addressed by the school policy

Section VL Admissions PoHey In the space provided describe the time1ine used for admitting students including the application deadline and the process for the admission of students by lottery (Although state law permits students to be accepted on a first come first served basis or through a lottery a charter schoo) that is oversubscribed must use a lottery to be eliaible to receive federal funds)

to TreetoPs is based on being an open enrollment school that uses the lottery system All policies and paperwork has the anti-discrimination statement as required by the TEC (12111) as well as being posted in the office and on the school web page The appliauion period for exempt (returning) students is from Manh 1 through March 28 For new applicants registration will be held from March 29 to April 30 Once the openings have been filled students whose names are not drawn are placed on a waiting list A lottery drawing will be held on March 29 Parents must complete the frist page ofthe enrollment form and provide copies ofsocial security card birth certificate and a copy of shot records before the enrollment may be complete The 2002-2003 enrollment forms may be downloaded and printed Admissions will not be based on gender national orgin ethnicity religion disability academic artistic athletic ability or the district the student would otherwise attend

Section VB Student Performance Goals In the spaces provided below identify the schools academic goals for student learning for the next five years in terms of AEIS base and additional indicators and other relevant performance information

Some accountability standards and criteria for 2004 and 2005 are available in the 2002 ACCOWIIability Manual which is available at TAKS passing standards for Exemplary and Recognized are the same as in 2002 Rating criteria and standards have not yet been determined beyond 2002 for completion rate dropout rate the State-Developed Alternative Assessment (SDAA) and the Academically Acceptable Acceptable rating

A AEIS Base Indicators Describe student performance goals in terms ofAEIS base indicators (ie T AAS scores and dropout rates) Be specific about indicators such as percentage ofstudents passing exams and annual dropout rates Note Campuses rated under the Alternative Education Accountability system may also have student attendance and Texas Learning Inder (lU) growth as base indicators

an years to scores to a level Tutorials are offered at all grade levels in an effort to improve performance scores and ratings There has been significant improvemeot in progress ofprior year TAAS fuilers as reflected in the average TLI Growth reading 2001 1357 as opposed to 750 in 2000 reading 429 to 2000 333 and math improving from 300 to 318 All passing tests went from 2000s score of532 to 583 Annual drop out rate continues to be low (08) and attendance rate continues to be in the 95th percentile AP test rates are 161 from 148 previous year There is a strong movement to offer more AP courses and to improve the reading level ofall students TreetoPs showed a 852 passing reading 574 passing writing and 654 passing math Math continues to show improvement but is the weak spot and is being addressed with change ofpersonnel and totorials Summer school is being offered at no clwge in math to help stmegthen skills our exemptions were below the state average at 06 Campus TLI average growth reflects 832 Out of 14 graduates this year 12 are college bound one is technical school bound and one joined the Air Force

B AEIS Additional Indicators Describe student performance goals in terms ofAEIS additional indicators (ie attendance rates 4-year completion rate college admissions testing and participation in the recommended high school program) Be specific about indicators such as average Texas Learning Index (TLl) growth year-to-year progress and accountability ratings NoteCampuses rated under the Alternative Education Accountability system may also have campus-selected additional indicators

rate was the school year with an annual drop out rate in comparison state average of 13 Every grader takes the PSAT and the PLAN tests at school in an effort to be prepared for the SAT and the ACT The 2001 avg TLI was 7536 and growth from 6704 the previous year

c Othu Relevant Perfonnnce Goas Describe other relevant student performance goals that may be unique to your school

are and enhance their the are offered daily in the morning and afternoons It has become a challenge to raise the of learning for each student that is being met head 011 Learning in cInsters has made a significant difference for our students as they mentor each other and make learning accessible to all Mentoring younger students has not only prepared the mentors in academic learning but also in life skills Comuunity service projects have been used as incentives to learn how to make use ofthe skills obtained in the classroom Community service projects are performed at aJ levels across the campus The TAKS will be readily understood by being prepared with practical examples It is our goal to bring the aCceptable rating to recognized this next year

Section vm Monitoring FoIlowUp Discuss improvements made and other actions taken to address any and aJ findings recommendations or sanctions by TEA including those resulting from monitoring on-site visits or hearings Provide specific information about compliance status with aJ special program indicators including corrective action plans for bilingual and special education programs and about PASIDAS risk levels

In compliance with the DEC review and the CAR visit there have beeu mauy changes at Treetops in splaquoia1 education bilingual and accounting procedures In April aU personnel connected to the adminstration was replaced Currently Region XI handles aU fmancial records pays all bills and issues all checks A fmancial system has been implemented where the hills are coded at the district sent to Region XI for review and checks are cut they are returned to the district for siguature and mailings Region XI is processing payroH PEIMS TRS deposits and health insurance In the 2001-2002 school year Region XI will also he handling aU attendance reporting The audits have beeu late due to previous accounting procedures and previous adminstrations which have aU changed as of April 2001 Bank reconciliations are current accounting reports are current credit cards are no longer being used the budget is in compliance with proper coding penonnel files are complete and documentation is kept in accordance to TEA and standard accounting procedure The CAR has generated ESL training for employees the hiring of two ESL teachers and the implementation ofa bilingual program even though Treetops cnrrently has no ESL students LPAC traioiug has been completed by three stafl memben and LEP procedures including the handbook have been implemented Special education reviews showed that we were laeking in documentation in previous yean Ardia Kentfield a Texas certified diagusotician was hired and has completed bringing aU the forms and files up to state requirements Inserviee was held on Dec 10 for assistive technology as weD as diseussion concerning the CAR visit and compliance The last ofthe doeumentation was seat to Austin on May 30 2001 to com~lete the follow u~visit ~

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 7: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Dr Mike Saclren

Kathy FJunan Clardy

Shelly Moyers

Coke

Meg Richter

Ray Howard

Janet McEwen

Karen Davidenko

SectiOD n Governance Structure and Procedures Review TEC Sec 12121 and 19 TAC Chapter 100 Division 5 (Charter School Governance) which lists among other things powers and duties that must be exercised by the governing body ofthe charter bolder and nepotism and conflict of interest prohibitions and exceptions

Where indicated list all relatives ofthe members ofthe Governing Body ofthe Charter Holder ofthe Governing Body ofthe Charter School and ofthe Officers ofthe Charter School within the third degree ofconsanguinity or affinity These include your spouse and the following relations to you and to your spouse parents children grandchildren siblings grandparents great-grandparents nieces nephews aunts uncles and great-grandchildren

A Goyeming Body of Charter Holder 1 In the spaces below please list the names ofthe members ofthe governing body ofthe charter bolder the offices held any board members relative within the third degree ofconsanguinity or affinity (see definition above) and any compensation or remuneration from the charter bolder or charter school received by the board members

OJ

President none none

Vice President none none

none none

Treasurer none none

At Large none none

Development none none

Public Relations none none

At none none

2 Will any relative ofthe board member within the third degree ofconsanguinity or affinity (see definition above) be employed by or receive any compensation or remuneration from the charter bolder or the charter school Ifyes provide details in the space provided below YES 0 NO 181

3 Will any boerd members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the cbarter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

4 Will any person who is a relative within the third degree ofconsanguinity or affinity (see definition on page 3) ofa charter school officer (ie a person charged with the duties of or acting as a chief executive officer a central administrator a campus administration officer or a business manager) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YESD NO[8l

B Govemi Bodv g$arter School I Ifthe governance structure includes more than one board (ie a governing body tbat is separate from the governing body ofthe charter holder) in the spaces below please list the names ofthe members ofthe governing body ofthe charter school the offices held any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) and any compensation or remuneration from the charter holder or charter school received by the board members

Board Member Ne Relative(s) Within the Third IJegne Board MemberOfJiuBeid or Couanguinity or AffiDity WOO Compensation or are Also Serting OR the Board RemJaeratiOD Per Year

2 Will any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or the charter school Ifyes provide details in space provided below YES 0 NO 121

3 Will any board members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

C Roles and Responsibilities of Governing Bodies Describe the roles and responsibilities ofboth the charter holder and charter school governing bodies Iftills represents a change from the goveroance structure currently on file with the Agency please indicate that it is a change and describe the difference from the previous structure

The Board ofDirectors is the policy making body ofTreetops International School and Mid-Cities Learning Center It is responsible for establishing the philosophy and objectives ofthe school for the effective implementation ofthese policies their review and evalnation in accordance with TEA requirements No change of duties

D Qamplzational ~hn Crimioll Historv Records BiotranlilaI Affillam bull Submit an organirntional chart Include this document as AttacbmeDt 1 Organizational Chart bull Submit a criminal history record for each board member Include these documents as AttacbmeDt 2 Criminal

History Records for Board Members bull Submit a biographical affidavit for each board member Include these documents as Attachment 3 Board

Member Biographical Affidavit

Section m Teacher QualifICations In the space provided describe the qualifications required for all classroom teachers and other instructional staff Ifthis represents a change from the charter application on file with the Agency or approved amendments please indicate that it is a change and describe the difference from the previous requirement

In with teacher are met with all having a high school Currently all teachers (25) are degreed 8 have masters one is completing her PhD and one has PhD It has been the standard to have a college degree to teach Treetops does not currently receive Title I funds but will insure that in the future all teachers in core areas are college graduates

Section IV Code ofCondurt In the space provided describe the methods used to inform parents and students about school rules and guidelines governing student behavior Include policies regarding student expulsion and suspension and procedures that satisfY due process requirements

posted on page are enrollment as well as distributed at the parent meeting or two days before school opens a copy is also in the office for public review This handbook covers policies on student attendance discipline and general operating guidelines ofthe school Ifthere is a need for discipline the parent is contacted by phone reguaIr mail and certified mail All discipline actions including student suspensions and expulsions are elligible for appeal to the school board but the decision ofthe Board is binding

Section V Complaints In the space provided descnbe the methods used to inform parents students and employees about the procedures for receiving and responding to complaints (Note Under 19 TAC sect 100 II0 l(e) the governing body ofa charter holder shall not delegate final authority to hear or decide employee grievances citizen complaints or parental concerns)

Parents and students a student during the open meeting 2 days prior to explains a grievance The policy is also on the web page (wwwtreetopsotg) is posted in the adtnirutration office and on the buIIetine board in the high school building Employees receive an employee handbook and attend inservice concerning procedures for filing a grievance The grievance policy is I) contact in writing the person grievance is with for a meeting 2) Ifnot resolved submit in writing to the Board ofDiredors the grievance 3) The Board will appoint a grievance conunittee formed ofone Board member a faculty member and a parent to review all written statements and interview all parties 4) Majority decisions by the Board are binding TEA continues to keep a record ofall complaints against Treetops and as complaints are released they are addressed by the school policy

Section VL Admissions PoHey In the space provided describe the time1ine used for admitting students including the application deadline and the process for the admission of students by lottery (Although state law permits students to be accepted on a first come first served basis or through a lottery a charter schoo) that is oversubscribed must use a lottery to be eliaible to receive federal funds)

to TreetoPs is based on being an open enrollment school that uses the lottery system All policies and paperwork has the anti-discrimination statement as required by the TEC (12111) as well as being posted in the office and on the school web page The appliauion period for exempt (returning) students is from Manh 1 through March 28 For new applicants registration will be held from March 29 to April 30 Once the openings have been filled students whose names are not drawn are placed on a waiting list A lottery drawing will be held on March 29 Parents must complete the frist page ofthe enrollment form and provide copies ofsocial security card birth certificate and a copy of shot records before the enrollment may be complete The 2002-2003 enrollment forms may be downloaded and printed Admissions will not be based on gender national orgin ethnicity religion disability academic artistic athletic ability or the district the student would otherwise attend

Section VB Student Performance Goals In the spaces provided below identify the schools academic goals for student learning for the next five years in terms of AEIS base and additional indicators and other relevant performance information

Some accountability standards and criteria for 2004 and 2005 are available in the 2002 ACCOWIIability Manual which is available at TAKS passing standards for Exemplary and Recognized are the same as in 2002 Rating criteria and standards have not yet been determined beyond 2002 for completion rate dropout rate the State-Developed Alternative Assessment (SDAA) and the Academically Acceptable Acceptable rating

A AEIS Base Indicators Describe student performance goals in terms ofAEIS base indicators (ie T AAS scores and dropout rates) Be specific about indicators such as percentage ofstudents passing exams and annual dropout rates Note Campuses rated under the Alternative Education Accountability system may also have student attendance and Texas Learning Inder (lU) growth as base indicators

an years to scores to a level Tutorials are offered at all grade levels in an effort to improve performance scores and ratings There has been significant improvemeot in progress ofprior year TAAS fuilers as reflected in the average TLI Growth reading 2001 1357 as opposed to 750 in 2000 reading 429 to 2000 333 and math improving from 300 to 318 All passing tests went from 2000s score of532 to 583 Annual drop out rate continues to be low (08) and attendance rate continues to be in the 95th percentile AP test rates are 161 from 148 previous year There is a strong movement to offer more AP courses and to improve the reading level ofall students TreetoPs showed a 852 passing reading 574 passing writing and 654 passing math Math continues to show improvement but is the weak spot and is being addressed with change ofpersonnel and totorials Summer school is being offered at no clwge in math to help stmegthen skills our exemptions were below the state average at 06 Campus TLI average growth reflects 832 Out of 14 graduates this year 12 are college bound one is technical school bound and one joined the Air Force

B AEIS Additional Indicators Describe student performance goals in terms ofAEIS additional indicators (ie attendance rates 4-year completion rate college admissions testing and participation in the recommended high school program) Be specific about indicators such as average Texas Learning Index (TLl) growth year-to-year progress and accountability ratings NoteCampuses rated under the Alternative Education Accountability system may also have campus-selected additional indicators

rate was the school year with an annual drop out rate in comparison state average of 13 Every grader takes the PSAT and the PLAN tests at school in an effort to be prepared for the SAT and the ACT The 2001 avg TLI was 7536 and growth from 6704 the previous year

c Othu Relevant Perfonnnce Goas Describe other relevant student performance goals that may be unique to your school

are and enhance their the are offered daily in the morning and afternoons It has become a challenge to raise the of learning for each student that is being met head 011 Learning in cInsters has made a significant difference for our students as they mentor each other and make learning accessible to all Mentoring younger students has not only prepared the mentors in academic learning but also in life skills Comuunity service projects have been used as incentives to learn how to make use ofthe skills obtained in the classroom Community service projects are performed at aJ levels across the campus The TAKS will be readily understood by being prepared with practical examples It is our goal to bring the aCceptable rating to recognized this next year

Section vm Monitoring FoIlowUp Discuss improvements made and other actions taken to address any and aJ findings recommendations or sanctions by TEA including those resulting from monitoring on-site visits or hearings Provide specific information about compliance status with aJ special program indicators including corrective action plans for bilingual and special education programs and about PASIDAS risk levels

In compliance with the DEC review and the CAR visit there have beeu mauy changes at Treetops in splaquoia1 education bilingual and accounting procedures In April aU personnel connected to the adminstration was replaced Currently Region XI handles aU fmancial records pays all bills and issues all checks A fmancial system has been implemented where the hills are coded at the district sent to Region XI for review and checks are cut they are returned to the district for siguature and mailings Region XI is processing payroH PEIMS TRS deposits and health insurance In the 2001-2002 school year Region XI will also he handling aU attendance reporting The audits have beeu late due to previous accounting procedures and previous adminstrations which have aU changed as of April 2001 Bank reconciliations are current accounting reports are current credit cards are no longer being used the budget is in compliance with proper coding penonnel files are complete and documentation is kept in accordance to TEA and standard accounting procedure The CAR has generated ESL training for employees the hiring of two ESL teachers and the implementation ofa bilingual program even though Treetops cnrrently has no ESL students LPAC traioiug has been completed by three stafl memben and LEP procedures including the handbook have been implemented Special education reviews showed that we were laeking in documentation in previous yean Ardia Kentfield a Texas certified diagusotician was hired and has completed bringing aU the forms and files up to state requirements Inserviee was held on Dec 10 for assistive technology as weD as diseussion concerning the CAR visit and compliance The last ofthe doeumentation was seat to Austin on May 30 2001 to com~lete the follow u~visit ~

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 8: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

3 Will any boerd members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the cbarter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

4 Will any person who is a relative within the third degree ofconsanguinity or affinity (see definition on page 3) ofa charter school officer (ie a person charged with the duties of or acting as a chief executive officer a central administrator a campus administration officer or a business manager) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YESD NO[8l

B Govemi Bodv g$arter School I Ifthe governance structure includes more than one board (ie a governing body tbat is separate from the governing body ofthe charter holder) in the spaces below please list the names ofthe members ofthe governing body ofthe charter school the offices held any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) and any compensation or remuneration from the charter holder or charter school received by the board members

Board Member Ne Relative(s) Within the Third IJegne Board MemberOfJiuBeid or Couanguinity or AffiDity WOO Compensation or are Also Serting OR the Board RemJaeratiOD Per Year

2 Will any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or the charter school Ifyes provide details in space provided below YES 0 NO 121

3 Will any board members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

C Roles and Responsibilities of Governing Bodies Describe the roles and responsibilities ofboth the charter holder and charter school governing bodies Iftills represents a change from the goveroance structure currently on file with the Agency please indicate that it is a change and describe the difference from the previous structure

The Board ofDirectors is the policy making body ofTreetops International School and Mid-Cities Learning Center It is responsible for establishing the philosophy and objectives ofthe school for the effective implementation ofthese policies their review and evalnation in accordance with TEA requirements No change of duties

D Qamplzational ~hn Crimioll Historv Records BiotranlilaI Affillam bull Submit an organirntional chart Include this document as AttacbmeDt 1 Organizational Chart bull Submit a criminal history record for each board member Include these documents as AttacbmeDt 2 Criminal

History Records for Board Members bull Submit a biographical affidavit for each board member Include these documents as Attachment 3 Board

Member Biographical Affidavit

Section m Teacher QualifICations In the space provided describe the qualifications required for all classroom teachers and other instructional staff Ifthis represents a change from the charter application on file with the Agency or approved amendments please indicate that it is a change and describe the difference from the previous requirement

In with teacher are met with all having a high school Currently all teachers (25) are degreed 8 have masters one is completing her PhD and one has PhD It has been the standard to have a college degree to teach Treetops does not currently receive Title I funds but will insure that in the future all teachers in core areas are college graduates

Section IV Code ofCondurt In the space provided describe the methods used to inform parents and students about school rules and guidelines governing student behavior Include policies regarding student expulsion and suspension and procedures that satisfY due process requirements

posted on page are enrollment as well as distributed at the parent meeting or two days before school opens a copy is also in the office for public review This handbook covers policies on student attendance discipline and general operating guidelines ofthe school Ifthere is a need for discipline the parent is contacted by phone reguaIr mail and certified mail All discipline actions including student suspensions and expulsions are elligible for appeal to the school board but the decision ofthe Board is binding

Section V Complaints In the space provided descnbe the methods used to inform parents students and employees about the procedures for receiving and responding to complaints (Note Under 19 TAC sect 100 II0 l(e) the governing body ofa charter holder shall not delegate final authority to hear or decide employee grievances citizen complaints or parental concerns)

Parents and students a student during the open meeting 2 days prior to explains a grievance The policy is also on the web page (wwwtreetopsotg) is posted in the adtnirutration office and on the buIIetine board in the high school building Employees receive an employee handbook and attend inservice concerning procedures for filing a grievance The grievance policy is I) contact in writing the person grievance is with for a meeting 2) Ifnot resolved submit in writing to the Board ofDiredors the grievance 3) The Board will appoint a grievance conunittee formed ofone Board member a faculty member and a parent to review all written statements and interview all parties 4) Majority decisions by the Board are binding TEA continues to keep a record ofall complaints against Treetops and as complaints are released they are addressed by the school policy

Section VL Admissions PoHey In the space provided describe the time1ine used for admitting students including the application deadline and the process for the admission of students by lottery (Although state law permits students to be accepted on a first come first served basis or through a lottery a charter schoo) that is oversubscribed must use a lottery to be eliaible to receive federal funds)

to TreetoPs is based on being an open enrollment school that uses the lottery system All policies and paperwork has the anti-discrimination statement as required by the TEC (12111) as well as being posted in the office and on the school web page The appliauion period for exempt (returning) students is from Manh 1 through March 28 For new applicants registration will be held from March 29 to April 30 Once the openings have been filled students whose names are not drawn are placed on a waiting list A lottery drawing will be held on March 29 Parents must complete the frist page ofthe enrollment form and provide copies ofsocial security card birth certificate and a copy of shot records before the enrollment may be complete The 2002-2003 enrollment forms may be downloaded and printed Admissions will not be based on gender national orgin ethnicity religion disability academic artistic athletic ability or the district the student would otherwise attend

Section VB Student Performance Goals In the spaces provided below identify the schools academic goals for student learning for the next five years in terms of AEIS base and additional indicators and other relevant performance information

Some accountability standards and criteria for 2004 and 2005 are available in the 2002 ACCOWIIability Manual which is available at TAKS passing standards for Exemplary and Recognized are the same as in 2002 Rating criteria and standards have not yet been determined beyond 2002 for completion rate dropout rate the State-Developed Alternative Assessment (SDAA) and the Academically Acceptable Acceptable rating

A AEIS Base Indicators Describe student performance goals in terms ofAEIS base indicators (ie T AAS scores and dropout rates) Be specific about indicators such as percentage ofstudents passing exams and annual dropout rates Note Campuses rated under the Alternative Education Accountability system may also have student attendance and Texas Learning Inder (lU) growth as base indicators

an years to scores to a level Tutorials are offered at all grade levels in an effort to improve performance scores and ratings There has been significant improvemeot in progress ofprior year TAAS fuilers as reflected in the average TLI Growth reading 2001 1357 as opposed to 750 in 2000 reading 429 to 2000 333 and math improving from 300 to 318 All passing tests went from 2000s score of532 to 583 Annual drop out rate continues to be low (08) and attendance rate continues to be in the 95th percentile AP test rates are 161 from 148 previous year There is a strong movement to offer more AP courses and to improve the reading level ofall students TreetoPs showed a 852 passing reading 574 passing writing and 654 passing math Math continues to show improvement but is the weak spot and is being addressed with change ofpersonnel and totorials Summer school is being offered at no clwge in math to help stmegthen skills our exemptions were below the state average at 06 Campus TLI average growth reflects 832 Out of 14 graduates this year 12 are college bound one is technical school bound and one joined the Air Force

B AEIS Additional Indicators Describe student performance goals in terms ofAEIS additional indicators (ie attendance rates 4-year completion rate college admissions testing and participation in the recommended high school program) Be specific about indicators such as average Texas Learning Index (TLl) growth year-to-year progress and accountability ratings NoteCampuses rated under the Alternative Education Accountability system may also have campus-selected additional indicators

rate was the school year with an annual drop out rate in comparison state average of 13 Every grader takes the PSAT and the PLAN tests at school in an effort to be prepared for the SAT and the ACT The 2001 avg TLI was 7536 and growth from 6704 the previous year

c Othu Relevant Perfonnnce Goas Describe other relevant student performance goals that may be unique to your school

are and enhance their the are offered daily in the morning and afternoons It has become a challenge to raise the of learning for each student that is being met head 011 Learning in cInsters has made a significant difference for our students as they mentor each other and make learning accessible to all Mentoring younger students has not only prepared the mentors in academic learning but also in life skills Comuunity service projects have been used as incentives to learn how to make use ofthe skills obtained in the classroom Community service projects are performed at aJ levels across the campus The TAKS will be readily understood by being prepared with practical examples It is our goal to bring the aCceptable rating to recognized this next year

Section vm Monitoring FoIlowUp Discuss improvements made and other actions taken to address any and aJ findings recommendations or sanctions by TEA including those resulting from monitoring on-site visits or hearings Provide specific information about compliance status with aJ special program indicators including corrective action plans for bilingual and special education programs and about PASIDAS risk levels

In compliance with the DEC review and the CAR visit there have beeu mauy changes at Treetops in splaquoia1 education bilingual and accounting procedures In April aU personnel connected to the adminstration was replaced Currently Region XI handles aU fmancial records pays all bills and issues all checks A fmancial system has been implemented where the hills are coded at the district sent to Region XI for review and checks are cut they are returned to the district for siguature and mailings Region XI is processing payroH PEIMS TRS deposits and health insurance In the 2001-2002 school year Region XI will also he handling aU attendance reporting The audits have beeu late due to previous accounting procedures and previous adminstrations which have aU changed as of April 2001 Bank reconciliations are current accounting reports are current credit cards are no longer being used the budget is in compliance with proper coding penonnel files are complete and documentation is kept in accordance to TEA and standard accounting procedure The CAR has generated ESL training for employees the hiring of two ESL teachers and the implementation ofa bilingual program even though Treetops cnrrently has no ESL students LPAC traioiug has been completed by three stafl memben and LEP procedures including the handbook have been implemented Special education reviews showed that we were laeking in documentation in previous yean Ardia Kentfield a Texas certified diagusotician was hired and has completed bringing aU the forms and files up to state requirements Inserviee was held on Dec 10 for assistive technology as weD as diseussion concerning the CAR visit and compliance The last ofthe doeumentation was seat to Austin on May 30 2001 to com~lete the follow u~visit ~

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 9: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

2 Will any relative ofa board member within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or the charter school Ifyes provide details in space provided below YES 0 NO 121

3 Will any board members spouse or any ofthe spouses relatives within the third degree ofconsanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or charter school Ifyes provide details in the space provided below YES 0 NO ~

C Roles and Responsibilities of Governing Bodies Describe the roles and responsibilities ofboth the charter holder and charter school governing bodies Iftills represents a change from the goveroance structure currently on file with the Agency please indicate that it is a change and describe the difference from the previous structure

The Board ofDirectors is the policy making body ofTreetops International School and Mid-Cities Learning Center It is responsible for establishing the philosophy and objectives ofthe school for the effective implementation ofthese policies their review and evalnation in accordance with TEA requirements No change of duties

D Qamplzational ~hn Crimioll Historv Records BiotranlilaI Affillam bull Submit an organirntional chart Include this document as AttacbmeDt 1 Organizational Chart bull Submit a criminal history record for each board member Include these documents as AttacbmeDt 2 Criminal

History Records for Board Members bull Submit a biographical affidavit for each board member Include these documents as Attachment 3 Board

Member Biographical Affidavit

Section m Teacher QualifICations In the space provided describe the qualifications required for all classroom teachers and other instructional staff Ifthis represents a change from the charter application on file with the Agency or approved amendments please indicate that it is a change and describe the difference from the previous requirement

In with teacher are met with all having a high school Currently all teachers (25) are degreed 8 have masters one is completing her PhD and one has PhD It has been the standard to have a college degree to teach Treetops does not currently receive Title I funds but will insure that in the future all teachers in core areas are college graduates

Section IV Code ofCondurt In the space provided describe the methods used to inform parents and students about school rules and guidelines governing student behavior Include policies regarding student expulsion and suspension and procedures that satisfY due process requirements

posted on page are enrollment as well as distributed at the parent meeting or two days before school opens a copy is also in the office for public review This handbook covers policies on student attendance discipline and general operating guidelines ofthe school Ifthere is a need for discipline the parent is contacted by phone reguaIr mail and certified mail All discipline actions including student suspensions and expulsions are elligible for appeal to the school board but the decision ofthe Board is binding

Section V Complaints In the space provided descnbe the methods used to inform parents students and employees about the procedures for receiving and responding to complaints (Note Under 19 TAC sect 100 II0 l(e) the governing body ofa charter holder shall not delegate final authority to hear or decide employee grievances citizen complaints or parental concerns)

Parents and students a student during the open meeting 2 days prior to explains a grievance The policy is also on the web page (wwwtreetopsotg) is posted in the adtnirutration office and on the buIIetine board in the high school building Employees receive an employee handbook and attend inservice concerning procedures for filing a grievance The grievance policy is I) contact in writing the person grievance is with for a meeting 2) Ifnot resolved submit in writing to the Board ofDiredors the grievance 3) The Board will appoint a grievance conunittee formed ofone Board member a faculty member and a parent to review all written statements and interview all parties 4) Majority decisions by the Board are binding TEA continues to keep a record ofall complaints against Treetops and as complaints are released they are addressed by the school policy

Section VL Admissions PoHey In the space provided describe the time1ine used for admitting students including the application deadline and the process for the admission of students by lottery (Although state law permits students to be accepted on a first come first served basis or through a lottery a charter schoo) that is oversubscribed must use a lottery to be eliaible to receive federal funds)

to TreetoPs is based on being an open enrollment school that uses the lottery system All policies and paperwork has the anti-discrimination statement as required by the TEC (12111) as well as being posted in the office and on the school web page The appliauion period for exempt (returning) students is from Manh 1 through March 28 For new applicants registration will be held from March 29 to April 30 Once the openings have been filled students whose names are not drawn are placed on a waiting list A lottery drawing will be held on March 29 Parents must complete the frist page ofthe enrollment form and provide copies ofsocial security card birth certificate and a copy of shot records before the enrollment may be complete The 2002-2003 enrollment forms may be downloaded and printed Admissions will not be based on gender national orgin ethnicity religion disability academic artistic athletic ability or the district the student would otherwise attend

Section VB Student Performance Goals In the spaces provided below identify the schools academic goals for student learning for the next five years in terms of AEIS base and additional indicators and other relevant performance information

Some accountability standards and criteria for 2004 and 2005 are available in the 2002 ACCOWIIability Manual which is available at TAKS passing standards for Exemplary and Recognized are the same as in 2002 Rating criteria and standards have not yet been determined beyond 2002 for completion rate dropout rate the State-Developed Alternative Assessment (SDAA) and the Academically Acceptable Acceptable rating

A AEIS Base Indicators Describe student performance goals in terms ofAEIS base indicators (ie T AAS scores and dropout rates) Be specific about indicators such as percentage ofstudents passing exams and annual dropout rates Note Campuses rated under the Alternative Education Accountability system may also have student attendance and Texas Learning Inder (lU) growth as base indicators

an years to scores to a level Tutorials are offered at all grade levels in an effort to improve performance scores and ratings There has been significant improvemeot in progress ofprior year TAAS fuilers as reflected in the average TLI Growth reading 2001 1357 as opposed to 750 in 2000 reading 429 to 2000 333 and math improving from 300 to 318 All passing tests went from 2000s score of532 to 583 Annual drop out rate continues to be low (08) and attendance rate continues to be in the 95th percentile AP test rates are 161 from 148 previous year There is a strong movement to offer more AP courses and to improve the reading level ofall students TreetoPs showed a 852 passing reading 574 passing writing and 654 passing math Math continues to show improvement but is the weak spot and is being addressed with change ofpersonnel and totorials Summer school is being offered at no clwge in math to help stmegthen skills our exemptions were below the state average at 06 Campus TLI average growth reflects 832 Out of 14 graduates this year 12 are college bound one is technical school bound and one joined the Air Force

B AEIS Additional Indicators Describe student performance goals in terms ofAEIS additional indicators (ie attendance rates 4-year completion rate college admissions testing and participation in the recommended high school program) Be specific about indicators such as average Texas Learning Index (TLl) growth year-to-year progress and accountability ratings NoteCampuses rated under the Alternative Education Accountability system may also have campus-selected additional indicators

rate was the school year with an annual drop out rate in comparison state average of 13 Every grader takes the PSAT and the PLAN tests at school in an effort to be prepared for the SAT and the ACT The 2001 avg TLI was 7536 and growth from 6704 the previous year

c Othu Relevant Perfonnnce Goas Describe other relevant student performance goals that may be unique to your school

are and enhance their the are offered daily in the morning and afternoons It has become a challenge to raise the of learning for each student that is being met head 011 Learning in cInsters has made a significant difference for our students as they mentor each other and make learning accessible to all Mentoring younger students has not only prepared the mentors in academic learning but also in life skills Comuunity service projects have been used as incentives to learn how to make use ofthe skills obtained in the classroom Community service projects are performed at aJ levels across the campus The TAKS will be readily understood by being prepared with practical examples It is our goal to bring the aCceptable rating to recognized this next year

Section vm Monitoring FoIlowUp Discuss improvements made and other actions taken to address any and aJ findings recommendations or sanctions by TEA including those resulting from monitoring on-site visits or hearings Provide specific information about compliance status with aJ special program indicators including corrective action plans for bilingual and special education programs and about PASIDAS risk levels

In compliance with the DEC review and the CAR visit there have beeu mauy changes at Treetops in splaquoia1 education bilingual and accounting procedures In April aU personnel connected to the adminstration was replaced Currently Region XI handles aU fmancial records pays all bills and issues all checks A fmancial system has been implemented where the hills are coded at the district sent to Region XI for review and checks are cut they are returned to the district for siguature and mailings Region XI is processing payroH PEIMS TRS deposits and health insurance In the 2001-2002 school year Region XI will also he handling aU attendance reporting The audits have beeu late due to previous accounting procedures and previous adminstrations which have aU changed as of April 2001 Bank reconciliations are current accounting reports are current credit cards are no longer being used the budget is in compliance with proper coding penonnel files are complete and documentation is kept in accordance to TEA and standard accounting procedure The CAR has generated ESL training for employees the hiring of two ESL teachers and the implementation ofa bilingual program even though Treetops cnrrently has no ESL students LPAC traioiug has been completed by three stafl memben and LEP procedures including the handbook have been implemented Special education reviews showed that we were laeking in documentation in previous yean Ardia Kentfield a Texas certified diagusotician was hired and has completed bringing aU the forms and files up to state requirements Inserviee was held on Dec 10 for assistive technology as weD as diseussion concerning the CAR visit and compliance The last ofthe doeumentation was seat to Austin on May 30 2001 to com~lete the follow u~visit ~

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 10: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Section m Teacher QualifICations In the space provided describe the qualifications required for all classroom teachers and other instructional staff Ifthis represents a change from the charter application on file with the Agency or approved amendments please indicate that it is a change and describe the difference from the previous requirement

In with teacher are met with all having a high school Currently all teachers (25) are degreed 8 have masters one is completing her PhD and one has PhD It has been the standard to have a college degree to teach Treetops does not currently receive Title I funds but will insure that in the future all teachers in core areas are college graduates

Section IV Code ofCondurt In the space provided describe the methods used to inform parents and students about school rules and guidelines governing student behavior Include policies regarding student expulsion and suspension and procedures that satisfY due process requirements

posted on page are enrollment as well as distributed at the parent meeting or two days before school opens a copy is also in the office for public review This handbook covers policies on student attendance discipline and general operating guidelines ofthe school Ifthere is a need for discipline the parent is contacted by phone reguaIr mail and certified mail All discipline actions including student suspensions and expulsions are elligible for appeal to the school board but the decision ofthe Board is binding

Section V Complaints In the space provided descnbe the methods used to inform parents students and employees about the procedures for receiving and responding to complaints (Note Under 19 TAC sect 100 II0 l(e) the governing body ofa charter holder shall not delegate final authority to hear or decide employee grievances citizen complaints or parental concerns)

Parents and students a student during the open meeting 2 days prior to explains a grievance The policy is also on the web page (wwwtreetopsotg) is posted in the adtnirutration office and on the buIIetine board in the high school building Employees receive an employee handbook and attend inservice concerning procedures for filing a grievance The grievance policy is I) contact in writing the person grievance is with for a meeting 2) Ifnot resolved submit in writing to the Board ofDiredors the grievance 3) The Board will appoint a grievance conunittee formed ofone Board member a faculty member and a parent to review all written statements and interview all parties 4) Majority decisions by the Board are binding TEA continues to keep a record ofall complaints against Treetops and as complaints are released they are addressed by the school policy

Section VL Admissions PoHey In the space provided describe the time1ine used for admitting students including the application deadline and the process for the admission of students by lottery (Although state law permits students to be accepted on a first come first served basis or through a lottery a charter schoo) that is oversubscribed must use a lottery to be eliaible to receive federal funds)

to TreetoPs is based on being an open enrollment school that uses the lottery system All policies and paperwork has the anti-discrimination statement as required by the TEC (12111) as well as being posted in the office and on the school web page The appliauion period for exempt (returning) students is from Manh 1 through March 28 For new applicants registration will be held from March 29 to April 30 Once the openings have been filled students whose names are not drawn are placed on a waiting list A lottery drawing will be held on March 29 Parents must complete the frist page ofthe enrollment form and provide copies ofsocial security card birth certificate and a copy of shot records before the enrollment may be complete The 2002-2003 enrollment forms may be downloaded and printed Admissions will not be based on gender national orgin ethnicity religion disability academic artistic athletic ability or the district the student would otherwise attend

Section VB Student Performance Goals In the spaces provided below identify the schools academic goals for student learning for the next five years in terms of AEIS base and additional indicators and other relevant performance information

Some accountability standards and criteria for 2004 and 2005 are available in the 2002 ACCOWIIability Manual which is available at TAKS passing standards for Exemplary and Recognized are the same as in 2002 Rating criteria and standards have not yet been determined beyond 2002 for completion rate dropout rate the State-Developed Alternative Assessment (SDAA) and the Academically Acceptable Acceptable rating

A AEIS Base Indicators Describe student performance goals in terms ofAEIS base indicators (ie T AAS scores and dropout rates) Be specific about indicators such as percentage ofstudents passing exams and annual dropout rates Note Campuses rated under the Alternative Education Accountability system may also have student attendance and Texas Learning Inder (lU) growth as base indicators

an years to scores to a level Tutorials are offered at all grade levels in an effort to improve performance scores and ratings There has been significant improvemeot in progress ofprior year TAAS fuilers as reflected in the average TLI Growth reading 2001 1357 as opposed to 750 in 2000 reading 429 to 2000 333 and math improving from 300 to 318 All passing tests went from 2000s score of532 to 583 Annual drop out rate continues to be low (08) and attendance rate continues to be in the 95th percentile AP test rates are 161 from 148 previous year There is a strong movement to offer more AP courses and to improve the reading level ofall students TreetoPs showed a 852 passing reading 574 passing writing and 654 passing math Math continues to show improvement but is the weak spot and is being addressed with change ofpersonnel and totorials Summer school is being offered at no clwge in math to help stmegthen skills our exemptions were below the state average at 06 Campus TLI average growth reflects 832 Out of 14 graduates this year 12 are college bound one is technical school bound and one joined the Air Force

B AEIS Additional Indicators Describe student performance goals in terms ofAEIS additional indicators (ie attendance rates 4-year completion rate college admissions testing and participation in the recommended high school program) Be specific about indicators such as average Texas Learning Index (TLl) growth year-to-year progress and accountability ratings NoteCampuses rated under the Alternative Education Accountability system may also have campus-selected additional indicators

rate was the school year with an annual drop out rate in comparison state average of 13 Every grader takes the PSAT and the PLAN tests at school in an effort to be prepared for the SAT and the ACT The 2001 avg TLI was 7536 and growth from 6704 the previous year

c Othu Relevant Perfonnnce Goas Describe other relevant student performance goals that may be unique to your school

are and enhance their the are offered daily in the morning and afternoons It has become a challenge to raise the of learning for each student that is being met head 011 Learning in cInsters has made a significant difference for our students as they mentor each other and make learning accessible to all Mentoring younger students has not only prepared the mentors in academic learning but also in life skills Comuunity service projects have been used as incentives to learn how to make use ofthe skills obtained in the classroom Community service projects are performed at aJ levels across the campus The TAKS will be readily understood by being prepared with practical examples It is our goal to bring the aCceptable rating to recognized this next year

Section vm Monitoring FoIlowUp Discuss improvements made and other actions taken to address any and aJ findings recommendations or sanctions by TEA including those resulting from monitoring on-site visits or hearings Provide specific information about compliance status with aJ special program indicators including corrective action plans for bilingual and special education programs and about PASIDAS risk levels

In compliance with the DEC review and the CAR visit there have beeu mauy changes at Treetops in splaquoia1 education bilingual and accounting procedures In April aU personnel connected to the adminstration was replaced Currently Region XI handles aU fmancial records pays all bills and issues all checks A fmancial system has been implemented where the hills are coded at the district sent to Region XI for review and checks are cut they are returned to the district for siguature and mailings Region XI is processing payroH PEIMS TRS deposits and health insurance In the 2001-2002 school year Region XI will also he handling aU attendance reporting The audits have beeu late due to previous accounting procedures and previous adminstrations which have aU changed as of April 2001 Bank reconciliations are current accounting reports are current credit cards are no longer being used the budget is in compliance with proper coding penonnel files are complete and documentation is kept in accordance to TEA and standard accounting procedure The CAR has generated ESL training for employees the hiring of two ESL teachers and the implementation ofa bilingual program even though Treetops cnrrently has no ESL students LPAC traioiug has been completed by three stafl memben and LEP procedures including the handbook have been implemented Special education reviews showed that we were laeking in documentation in previous yean Ardia Kentfield a Texas certified diagusotician was hired and has completed bringing aU the forms and files up to state requirements Inserviee was held on Dec 10 for assistive technology as weD as diseussion concerning the CAR visit and compliance The last ofthe doeumentation was seat to Austin on May 30 2001 to com~lete the follow u~visit ~

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 11: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Section VL Admissions PoHey In the space provided describe the time1ine used for admitting students including the application deadline and the process for the admission of students by lottery (Although state law permits students to be accepted on a first come first served basis or through a lottery a charter schoo) that is oversubscribed must use a lottery to be eliaible to receive federal funds)

to TreetoPs is based on being an open enrollment school that uses the lottery system All policies and paperwork has the anti-discrimination statement as required by the TEC (12111) as well as being posted in the office and on the school web page The appliauion period for exempt (returning) students is from Manh 1 through March 28 For new applicants registration will be held from March 29 to April 30 Once the openings have been filled students whose names are not drawn are placed on a waiting list A lottery drawing will be held on March 29 Parents must complete the frist page ofthe enrollment form and provide copies ofsocial security card birth certificate and a copy of shot records before the enrollment may be complete The 2002-2003 enrollment forms may be downloaded and printed Admissions will not be based on gender national orgin ethnicity religion disability academic artistic athletic ability or the district the student would otherwise attend

Section VB Student Performance Goals In the spaces provided below identify the schools academic goals for student learning for the next five years in terms of AEIS base and additional indicators and other relevant performance information

Some accountability standards and criteria for 2004 and 2005 are available in the 2002 ACCOWIIability Manual which is available at TAKS passing standards for Exemplary and Recognized are the same as in 2002 Rating criteria and standards have not yet been determined beyond 2002 for completion rate dropout rate the State-Developed Alternative Assessment (SDAA) and the Academically Acceptable Acceptable rating

A AEIS Base Indicators Describe student performance goals in terms ofAEIS base indicators (ie T AAS scores and dropout rates) Be specific about indicators such as percentage ofstudents passing exams and annual dropout rates Note Campuses rated under the Alternative Education Accountability system may also have student attendance and Texas Learning Inder (lU) growth as base indicators

an years to scores to a level Tutorials are offered at all grade levels in an effort to improve performance scores and ratings There has been significant improvemeot in progress ofprior year TAAS fuilers as reflected in the average TLI Growth reading 2001 1357 as opposed to 750 in 2000 reading 429 to 2000 333 and math improving from 300 to 318 All passing tests went from 2000s score of532 to 583 Annual drop out rate continues to be low (08) and attendance rate continues to be in the 95th percentile AP test rates are 161 from 148 previous year There is a strong movement to offer more AP courses and to improve the reading level ofall students TreetoPs showed a 852 passing reading 574 passing writing and 654 passing math Math continues to show improvement but is the weak spot and is being addressed with change ofpersonnel and totorials Summer school is being offered at no clwge in math to help stmegthen skills our exemptions were below the state average at 06 Campus TLI average growth reflects 832 Out of 14 graduates this year 12 are college bound one is technical school bound and one joined the Air Force

B AEIS Additional Indicators Describe student performance goals in terms ofAEIS additional indicators (ie attendance rates 4-year completion rate college admissions testing and participation in the recommended high school program) Be specific about indicators such as average Texas Learning Index (TLl) growth year-to-year progress and accountability ratings NoteCampuses rated under the Alternative Education Accountability system may also have campus-selected additional indicators

rate was the school year with an annual drop out rate in comparison state average of 13 Every grader takes the PSAT and the PLAN tests at school in an effort to be prepared for the SAT and the ACT The 2001 avg TLI was 7536 and growth from 6704 the previous year

c Othu Relevant Perfonnnce Goas Describe other relevant student performance goals that may be unique to your school

are and enhance their the are offered daily in the morning and afternoons It has become a challenge to raise the of learning for each student that is being met head 011 Learning in cInsters has made a significant difference for our students as they mentor each other and make learning accessible to all Mentoring younger students has not only prepared the mentors in academic learning but also in life skills Comuunity service projects have been used as incentives to learn how to make use ofthe skills obtained in the classroom Community service projects are performed at aJ levels across the campus The TAKS will be readily understood by being prepared with practical examples It is our goal to bring the aCceptable rating to recognized this next year

Section vm Monitoring FoIlowUp Discuss improvements made and other actions taken to address any and aJ findings recommendations or sanctions by TEA including those resulting from monitoring on-site visits or hearings Provide specific information about compliance status with aJ special program indicators including corrective action plans for bilingual and special education programs and about PASIDAS risk levels

In compliance with the DEC review and the CAR visit there have beeu mauy changes at Treetops in splaquoia1 education bilingual and accounting procedures In April aU personnel connected to the adminstration was replaced Currently Region XI handles aU fmancial records pays all bills and issues all checks A fmancial system has been implemented where the hills are coded at the district sent to Region XI for review and checks are cut they are returned to the district for siguature and mailings Region XI is processing payroH PEIMS TRS deposits and health insurance In the 2001-2002 school year Region XI will also he handling aU attendance reporting The audits have beeu late due to previous accounting procedures and previous adminstrations which have aU changed as of April 2001 Bank reconciliations are current accounting reports are current credit cards are no longer being used the budget is in compliance with proper coding penonnel files are complete and documentation is kept in accordance to TEA and standard accounting procedure The CAR has generated ESL training for employees the hiring of two ESL teachers and the implementation ofa bilingual program even though Treetops cnrrently has no ESL students LPAC traioiug has been completed by three stafl memben and LEP procedures including the handbook have been implemented Special education reviews showed that we were laeking in documentation in previous yean Ardia Kentfield a Texas certified diagusotician was hired and has completed bringing aU the forms and files up to state requirements Inserviee was held on Dec 10 for assistive technology as weD as diseussion concerning the CAR visit and compliance The last ofthe doeumentation was seat to Austin on May 30 2001 to com~lete the follow u~visit ~

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 12: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

B AEIS Additional Indicators Describe student performance goals in terms ofAEIS additional indicators (ie attendance rates 4-year completion rate college admissions testing and participation in the recommended high school program) Be specific about indicators such as average Texas Learning Index (TLl) growth year-to-year progress and accountability ratings NoteCampuses rated under the Alternative Education Accountability system may also have campus-selected additional indicators

rate was the school year with an annual drop out rate in comparison state average of 13 Every grader takes the PSAT and the PLAN tests at school in an effort to be prepared for the SAT and the ACT The 2001 avg TLI was 7536 and growth from 6704 the previous year

c Othu Relevant Perfonnnce Goas Describe other relevant student performance goals that may be unique to your school

are and enhance their the are offered daily in the morning and afternoons It has become a challenge to raise the of learning for each student that is being met head 011 Learning in cInsters has made a significant difference for our students as they mentor each other and make learning accessible to all Mentoring younger students has not only prepared the mentors in academic learning but also in life skills Comuunity service projects have been used as incentives to learn how to make use ofthe skills obtained in the classroom Community service projects are performed at aJ levels across the campus The TAKS will be readily understood by being prepared with practical examples It is our goal to bring the aCceptable rating to recognized this next year

Section vm Monitoring FoIlowUp Discuss improvements made and other actions taken to address any and aJ findings recommendations or sanctions by TEA including those resulting from monitoring on-site visits or hearings Provide specific information about compliance status with aJ special program indicators including corrective action plans for bilingual and special education programs and about PASIDAS risk levels

In compliance with the DEC review and the CAR visit there have beeu mauy changes at Treetops in splaquoia1 education bilingual and accounting procedures In April aU personnel connected to the adminstration was replaced Currently Region XI handles aU fmancial records pays all bills and issues all checks A fmancial system has been implemented where the hills are coded at the district sent to Region XI for review and checks are cut they are returned to the district for siguature and mailings Region XI is processing payroH PEIMS TRS deposits and health insurance In the 2001-2002 school year Region XI will also he handling aU attendance reporting The audits have beeu late due to previous accounting procedures and previous adminstrations which have aU changed as of April 2001 Bank reconciliations are current accounting reports are current credit cards are no longer being used the budget is in compliance with proper coding penonnel files are complete and documentation is kept in accordance to TEA and standard accounting procedure The CAR has generated ESL training for employees the hiring of two ESL teachers and the implementation ofa bilingual program even though Treetops cnrrently has no ESL students LPAC traioiug has been completed by three stafl memben and LEP procedures including the handbook have been implemented Special education reviews showed that we were laeking in documentation in previous yean Ardia Kentfield a Texas certified diagusotician was hired and has completed bringing aU the forms and files up to state requirements Inserviee was held on Dec 10 for assistive technology as weD as diseussion concerning the CAR visit and compliance The last ofthe doeumentation was seat to Austin on May 30 2001 to com~lete the follow u~visit ~

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 13: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

In compliance with the DEC review and the CAR visit there have beeu mauy changes at Treetops in splaquoia1 education bilingual and accounting procedures In April aU personnel connected to the adminstration was replaced Currently Region XI handles aU fmancial records pays all bills and issues all checks A fmancial system has been implemented where the hills are coded at the district sent to Region XI for review and checks are cut they are returned to the district for siguature and mailings Region XI is processing payroH PEIMS TRS deposits and health insurance In the 2001-2002 school year Region XI will also he handling aU attendance reporting The audits have beeu late due to previous accounting procedures and previous adminstrations which have aU changed as of April 2001 Bank reconciliations are current accounting reports are current credit cards are no longer being used the budget is in compliance with proper coding penonnel files are complete and documentation is kept in accordance to TEA and standard accounting procedure The CAR has generated ESL training for employees the hiring of two ESL teachers and the implementation ofa bilingual program even though Treetops cnrrently has no ESL students LPAC traioiug has been completed by three stafl memben and LEP procedures including the handbook have been implemented Special education reviews showed that we were laeking in documentation in previous yean Ardia Kentfield a Texas certified diagusotician was hired and has completed bringing aU the forms and files up to state requirements Inserviee was held on Dec 10 for assistive technology as weD as diseussion concerning the CAR visit and compliance The last ofthe doeumentation was seat to Austin on May 30 2001 to com~lete the follow u~visit ~

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 14: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Part 2 SJ)laquoial Needs StudentsIPrograms

NOTE The approval ofthis charter school renewal applliation andor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge ofspeciaI education Approval of the charter school renewal application andor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope ofthis renewal application process or actions that may have occurred since this renewal applliation process

Section IX IDEA Key Components Descnoe IN DETAIL (m the order requested and In tile IJfHlU provided below) how the charter scbooIaccommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board ofEducation rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy ofthe charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas SilJeby-Side is available online to assist the application process httollwwwteastatetLusmttia rdlrnIeslsbsbtmL

A Child Find (34 CFR 300125)

Treetops reaches out to the community in a ways to parents parties of the special education services available at our school This information can be found on our web page and the school handbook Flyers are distributed to parents ofenrolled students and parents considering making applliation for enrollment as well as during kindergarten round up Posters are in the adrninstration offices Pediatricians in the Fort Worth Arlington and the mid-cities area also receive copies ofthe flyer A notice is placed in local newspapers three times a year

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26(04)

ofschool records special education records the of is addressed at a fucnIty meeting at the beginning of the school year Written policy is distributed Personally identifiable information regarding special education students is kept in locked storage ElIigibility fulders are kept in the diagnosticians office and a copy ofthe current IEP is kept in an office area that is accessable to educational staff that have direct responsibility for serving that student There is a posted published list of those who may have access to the information in order to provide appropriate services and implement the students IEP Ifa person not identified on the posted list can show reason that they need access to confidential information they must sign that they were given access to the folder date and reason Confidential records are mailed to another school district when notice is received that the student has transfened to that district

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 15: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

C Procedural Safeguards (34 CFR 300504)

A copy ofprocedural safeguards is provided and explained to the parents prior to referral for special education services A signed receipt from the parent guardian surrogate parent or adult student is required for intial distribution only Additional copies ofthe proeedural safeguards are provided each time a notice is given or a cousent is requested In addition to providing continual assitance to parents to help them understand their rights under the law (IDEA) a list of 12 other resources can be found at the end of the document

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR300503 34 CFR3oo345 TEe 260081 19TAC 891015 19 TAC 891045)

Notcie ofatlmissiQD review dismissal (ARD) committee meeting A written notice ofan ARD meeting is mailed to the parentlguardianlsurrogate parentladult student iu a timely manner insuring that the parent bas a minimum of 5 school days advanced notice prior to the scheduled meeting In addition to providiug the date time and place ofthe meeting the notice iucludes the purpose ofthe meeting options considered before convening the meeting persons iuvited to the meeting and evaluation procedures that win be discussed The notice offers the arent the opportunity to reschedule the meeting to a more convenient mutually agreeable time ifneeded The parent may waive their right to the five school day wait prior ifthe nature ofthe ARD or the parents schedule necessitates it Multiple notices are given to iusure the parents participation A copy ofthe ProcedoraI Safeguards is iucluded with the notice ofARD

E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEe 29004 19TAC 89l011 19TAC 891015 19TAC 891040)

Enigtbility testing (FIE) is done when a student is referred throogh general education at ARD request or when reveiwed every three tears On intial referrals parentsguardianslsurrogate parentsadult students must receive a copy and expIanation ofthe procedural safeguards followed by notice ofthe iutent to evaluate and giving their signature on the evaluation consent fonn Parents are also asked to complete a questionaire regarding the students fumily history school history and health The referring classroom teacher provides information on academic progree and work samples Testing by a phyisiean psychologist speech therapist or a related service professional may also be iudicated The ARD committee must review test results withiu 30 days from the time the assessment report is written Ifadditional assessment is requested after the placement a committee must meet to review current formal assessemnt and informally collected information The committee makes a fonna1 recommendation as to the type ofevaluation information that will be needed The parent must be given a copy ofthe procedural safeguards before beiug given the notice ofevaluation and asked to give written consent Parent permission must be given before the testing can be done Although the law does not specifically state that the new assessment must be reviewed withiu 30 days from the time the report is written it is good practice to do so Students must meet all criteria for the area ofeligibility iudicated There must be educational need and the student must not be academically delayed because of lack ofprevious educational opportunity

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 16: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

F Development and implementation of the individualized educational program (IEP) Exteuded school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19TAC 891050 19 TAC 891053 19TAC

891055 19TAC 891065)

An IEP is developed after reviewing present levels ofeducational functioning forma1 assessment infonnation and infonnation from the parent Once educational strengths amd meeds are determined measurable goals and objectives are developed IEPs nwst be in effect after initial determination ofeligIbility and educational need development ofgoals and objectives and placement in the least restrictive environment The committee then determines what modifications must be ade in the students program to help them receive sum benefit from their educational experience ARD determined modifications must be consistently implemented by general education staff serving the student the general education teacher must be able to show how the modifications are implemented in their classroom Next the ARD committee determines the type ofcriterion teferenced assessment or end ofcourse examinations the student will take The committee then determines the type ofservices the student needs to implement the IEP in the least restrictive environment The review ofthe students IEP not less than annually to determine whether the annauI goals ofthe students are being achieved The review ofthe IEP willi address any lack ofexpected progress toward the annual goals and in the general curriculum ofappropriate the resuIts ofany reevaluation conducted infonnation about the student provided to or by the parents as described in the review of existing evaluations the students needs and other matters as appropriate Ifa student shows a pattern ofsevere regression in academic behavioral or related service skills development that cannot be recouped within a reasonable amount oftime and that would require the student ot be placed in a more restrictive environment or require additional services the ARD connnittee must consider ESY The form and type of services provided are to prevent severe regression Treetops School understand that a written report ofa full evaluation and individual education evaluation ofa student for proposed special education services shall be completed not later than the 601h calendar day followingf the date on which referraJs were initiated The ARDIIEP connnittee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date opf the completion ofthe written report The ARD team shall consisit of one or both parents a general education teacher a special ed teacher and an adminstrnlor Also included may be a speech pathologist diagnostwian occupational therapist or psychologist or other professionals as needed Parents will be given a copy ofthe IEP without charge A parent may request a conference or ARDIIEP committee meeting at any mutually agreeable time to address specific cocnerns about the students sp[ecial education

G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

ampiucational services must be provided in the least restrictive environment with the student age appropriate peers When determining how a special education students educational needs can be met any deviation from general education placement must be seriously considered The school must provide a contitntum ofservices and document why a more restrictive placement is necessary and what adverse affects the placement may have on the student

H Transition planning (34 CFR3oo29 TEe 29011 19 TAC 891110)

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 17: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Beginning by the age of 14 (younger ifthe student has severe disabilities) the AID committee must address transition planning and the services that must provided in order for the student to make a successful transition to adult life after high school graduation By age 16 Individual Transition Planning (ITP) meetings are held Included in the plan are insJructional activities which will help to prepare the studenJ tQ achieve their future goals The ITP meetings may also include representatives ofadult service agencies who may be able to provide services for the student

I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

Treetops certified personnel includes general education teachers a special education teacher speech therapist occupational therapists a licensed professional counselor ESL teachers and diagoostician Iuservice oppottumities have been provided for Scottish Rite Dyslexia training Autism and Aspergers Syndrome training and the implemenJation of AT devices or services The Dyslexia general education meeting is also conducted during the first week ofinservice t better prepare all teachers Educational opportunities are enwuraged to all fiIcuIty members Region XI offers continuing education classes for CEU hours

J Services to expelled students (34 CFR 300121(d) 34 CFR 300522 TEe Chapter 31- 10 day rule)

Ifa student commits an expellable offence the ARD committee is responsible for meeting to determine if the behavior is a manisfestation oftheir handicapping eondition Once that has been determined the committee decides what type of educational materials are to be made available to the student so they can conJinue with academics until they retorn to school The student does not get credit for work done while expeUed but it does provide them with support so that they do not get farther behind The work is prepared by the students teachers and is picked up and returned completed by a friend or familiy member

K AUowabie apenditures of state speeial education (unds (19 TAC 891125)

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 18: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Salaries paid from special education funds shaH provide instruction support services and education to the general and special education teachers and students Monies may he used for supplies directly related to the development and implementation ofIEPs and such are not regularly purchased for a classroom Funds may be used for contracting consultants tJansporation to and from residential fucilities inservice for both teachers and parents Persomell assigned to provide support services may be funded At Treetops our special education teacher and diagnostician are partially funded from state special education funds She provides homebound services special education resources inservcie materials and training Occupational therapy and speech therapy are also being charged to special education funds

CFR~Code ofFederal ReguIatioos TEO-Texas Education Code TAC=Texas Admjnjsuative Code

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 19: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

A Current copy of the charter schools informational brochureIpamphiet

B Current blank copy ofthe initial pre-selection data sheet for potential students - the form or student information requested for the charter schools admission method (ie lottery etc)

C Current blank copy ofthe student enrollment card once the student is selected for enrollment in the charter school

D As part ofAttachment 4 provide a brief description ofthe charter schools instructional arrangementssettings (mainstreammiddot resource roomservices self-contained etc) implemented for the provision ofspecial education and related servicesmiddotmiddot This description is not limited to but must include information on the location ofservices (in relation to the general education setting) and the staffing ofpersonnel

bull H the charter school bas students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide information on the provision ofsupport services by qualified special education personnel

Currently if the charter school bas no students with disabilities receiving special education and related services then provide information based on previous school years H the charter school bas never had students with disabilities receiving special education and related services then provide information based on the possibility ofthe enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAnacbment 4 provide a brief description of the charter schools system for placement decisionsmiddot with tJansfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

Hthe initial placement prior to the 30-day tJansfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

further on please contact Carolyn Dietrich in the Division of

Special Education (512-463-9362)

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 20: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Attachment 1 Organizational Chart

BOARD OF DIRECTORS The Board ofDirectors is the policy making body determines the objectives ofthe school and supervises the implementation ofthese policies The Board ofDirectors offers assurance that the school is in compliance with all constitutional and statutory law The Board ofDirectors serves without compensation is self-perpetuating and is mandated to confidentiality The Board is responsible for hiring of school Director

Executive CommitteelPresident serves as long range planning committee Secretary maintain records ofBoard business Community responsible for school recognition and community outreach Treasurer Budgets planning Development Fund raising Property Reviews maintenance and construction on property Parliamentarian communication Public Relations media releases At Large

DIRECTOR OF SCHOOL The Director is responsible for the operation ofthe school under and in accordance with the policies established by the Board and TEA The Director recommends policies overall plans and an annual budget to the Board hiring and firing offacuhy supervise fundraising and publicity teacher appraisals (PDAS) and oversee routine maintenance of the facility Must have MA or PhD and will meet the requirements as specified by SACS and TEA

F ACUL TY Teachers must have a minimum of high school diploma or qualifications as set out in the TEC code Teachers are under contract one year with a twelve-month salary installment Teachers will engage in on going professional development PDAS and consuh with Director concerning school matters

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 21: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Attachment 2 Criminal Background Check for ALL Board Members

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 22: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

In order to conceal personal information the result of a Criminal History Check

has been withheld

For more information please contact

Texas Education Agency Division of Charter Schols

1701 N Congress Ave Austin TX 78701

512-463-9575 Phone 512-463-9732 Fax

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 23: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Attachment 3 Board Member Affidavits

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 24: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

______

S~NI BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 1036AU PAGE 2

TEXAS EDUCATION AGENCY OPEN-ENROJLMJlNT CHARTER SCHOOL APFUCANT

BIOGRAPIDCAL AFFIDAVIT (MUST DE TYPED nd NOTARIZED)

Cbeck all dlat apply ~ M~Itlx ofthe governing board of the sponsoring entity Member of the managing board for the charter school

It should Ie understood that a board members resignation may not be effective ll1ltil a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Jo~itioo as defmed in TEe 121012

Full Name of SponsorlDg EDttty

Fun Name of Proposed CIlarter School

In cOIll1cction with the above-named argauizatioo and charler school application I herewith makA repreSlt1ttations and supply information about myself as hereinafter set forth (Attach addendum or sepaxate sheet jfspace hereon is insufficient to answer any qUllllions fully)

( IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not bull I 1 r shyAcceptable) DOIltIt M t1 ao( gt0lt ______

2 Haw you ever had your name changed or used another name -0-=-___

IIyes give reason fur the ~e ______________________

bMaidcn NatTIe (if female)

c Other names used at any time

3 Social Security Number

4 DmiddotteandPlaceofHirth_S -ti-4-g ~Qt A--fkll l(

5 Business Address TcU a6) zen1VO F+ Wortt 76129 Business Telcphone 811- lSi -6114

6 list your residences for the last ten (10) years starting with your cunent address giving

DATES ADDRESS CIlY AND STATE ZIPeODE

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 25: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

SENT BY TCU SCHOOL OF EDUCATION 8172577701 MAYmiddot14middot02 10aBAM PAClE 35

( 7611amp

7 Education Dates Name~ Locations and Degrees

College B A A- Ausb 1t1V

S List Membership in Professional Societies and AsOCiations _______________

9 List complete employment recurd (up to and including present jobs positions directorates ot officerships) forthe past twenty (20) years

DATES TIMPLOYFR ADDRESS TIlLE

(

10 Present employer may be contacted reg No (Circle One)

Former employerlt may be contacted ~ No (Circle One)

List all previous experience with charter schools Tnclude open-enrolbnent bools andor campus or program cbarter

DATHS EMPLOYER ADDRESS flTLE

Lisl all previous cxperience with any charter school management company

DATES EMPLOYER ADDRESS nlLE

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 26: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

------- ----------------------------------------------------

B~NI ~Y fCU SCHOOL O~ ~OUCATION 8172577701 j MAY-14-02 1036AMj PAGE 45

( 11 a) Have you ever been in a position which required II fidelity bond_~O Ifany

claims were made on tin bond give details ______________________

b) Have you ever been denied an individual or pu~itiOJ1 schedule fidelity boud or had a bond cancelled or revoked I)()Ifyes give details __________________________________

12 List any professional OCCllpalional or vocational licenses issued by any public or goveromental licensing agency or regulatory authority which you presently hold or have held in the past (State date I icense was issueQ issueof lic~ da~ taminatedJeasltmsfur I

termination) r t oLr d Stte JjoII~ C7t0f~ I 1 -ra 2 r4s5=shy_ IQIOCAuM kip ~rv r W islO_ 3i frAcenti---QL__-Ict=w~_________

13 During the last ten (10) years have you ever been refused II professional occupational or ocallonallicense by any public or govemmentallicensina agency or regulatory authority or has such license held by you ever been suspended or revokedi Mgt Ifyes lIive details ______

14 txplain any compensation that you expect to receive tom yOUT association with the pon-oring entily the charter school or a management company oCthe school

POS1TION COMPENSATION(

15 Will you or any relative within the third degree ofcouunguinity (ie parent grmdparent great-grandparent child grandchild greatmiddotgnmdohild sibling aunt uncle niece nephew) be ~11ployed by or receive any compensation or remuneration from the gpoosoring entity or the proposed charter school --ND Tfycs give delails _______________________

16 Will your spouse or lillY ofyour spouse relativ within the third degree of oonsanguinity (ie hill or her parent grandpamtt great-graudparent child grandchild areatmiddotgrandchild sihling aunt uncle niece nephew) be employed by or =eivc aft) compen~tion or TL-muncration tmm the spDJIlIOring entity or the proposed chamr school tJO If yes give details

17 Have you ever been adjudged bankrupt_LIl-O=-_______________________

(

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 27: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

__ _

18 Have you ever been convicted or had a sentence imposed Or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency_~gt()~_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect toi became insolvent or wplaced under supervision or in receivership rehabilitation liquidation or conservatorship---Md=-______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit ~ If so please furnish details ____________________

Dated and signed this L~ day of MOM 20 Q 2 at ~ jt()cyenY 111 ~

I hereby certify under penalty ofpetjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

middotCLQM~~ ~ (Signature ofAffiant)

Stateo~

County of ~~ Personally appeared before me the above named ~ b ( ~ Ult) personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

e ~

~ill ill ~

Lou Blanohard NotIfY Public Stall 01 TIllIS

IIIComIIiIHI EIqikII

JUNE11~

of hislher knowledge and belief

Subscribed and sworn to before me this _--_L~~ 20 ())

(SEAL)

6l~)ML~ My commission expires p - -Qj

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 28: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that apply [8] Member of the governing board of the sponsoring entity o Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Full Name of Proposed Charter School

In connection with the above-named organization and charter school application I herewith make representations and supply infonnation about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) KaTHY pound fIVIANN- CLA RIgt

2 Have you ever had your name changed or used another name -1Ic5---__

Ifyes give reason for the change ~Vl--A1g=elC4-(TPr__________________

bMaiden Name (if female) _otHrLM-JAuofll-N---__________________

c Other names used at any time _________________________

3 Social Security Number

4 Date and Place of Birth ---=7_-1--gt5----=5-amp----amp-0M---y----A-J~-fi--oRcpound=_B___A__Slt_6=I_fI-IJicte7-D---~--G=-O 5 Business Address_lr_JO-=N-=-=E=-________________________

Business Telephone--N=-O-NE=--______________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 29: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

7 Education Dates Names Locations and Degrees

College (NIGIfL-s I TV of NoCCi-l rrgtltIS I DENtV N

Graduate Studies $YlU -- DIltLAS CQllf5euroUiOe rowWD As ~(jvfl 19 00 - e 1--~ rtv - fQlaquo-r IJ)o~1+ M64 gt PloCraAtVI - NO DEGeGsect

8 v

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

ADDRESS TITLEEMPLOYER

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

Cz Of X - pf2p)eM tQee-Iof$ 6Xf)gJ

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

NONamp

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 30: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

11 a) Have you ever been in a position which required a fidelity bond IfanyI 5 claims were made on the bond give details ~bI-(ollLrV-=E~_________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled orrevoked__~~vl~O~_________________________ If yes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) tVO lJ 6

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked (I0 Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

(IOD~

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school 10 Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tJ 6 If yes give details

17 Have you ever been adjudged bankrupt --N~~O___________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 31: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any infonnation or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __N=-O---____

Ifyes give details ______________________________

19 Haveyou ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship-~SL-------------shy

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit1F2 If so please furnish details 41J111gtF ~~J gtMAU- UA AS 51 ashytAI A~~-Oyen~ t-DI ()( I crv I~ 2 CEJ 1~I~Lu

Dated and signed this 1~ at -F6CJltgt

I hereby certify under penalty ofpe ury that I am acting 0 my own be alf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ ~~W~ State of JViIAP

County of -JM t

Personally appeared before me the above named-=-)(tJU~=_--J~~~~~________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

t1 ~ Ur Subscribed and sworn to before me this ___-++____ day of_jJ)LLuliI--___

20 01 1

Lou Blanchard AJ(1J~~~~~t~______ _ e NtIIIry Pwllc Stale 01 TeKaS JJJt~1tlbJic)~ shy ~bull My ComnUOIOn ExpiIoIStZ JUNE 11 2004

My commission expires ~ - II--t Y

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 32: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applylS(Member of the governing board of the sponsoring entity j8fMember of the managing board for the charter school It should be understood that a board members resignation may not be effective until a

replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEe 121012

Full Name of Sponsoring Entity (y~ (-is bpoundJgtriis cpound-sh--shy

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fuJly)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) amp1kiE amp~f+oN Shw)oxs Cooyt0 mOI~rs

2 Have you ever had your name changed or used another name lj t- egtbull

Ifyes give reason for the change L(YIliOlJL-(=LJJiclCisectyenf=S-_________________

bMaiden Name (iffemale) __shr--fNu-LS~--________________

cOthernarnes used at any time t-Sht-Il1 s br-t3ilf 2 5hd lj (100 giilJ) r sh~lll)l[)Yfr5 3 Social Security Number

5 Business Address_~Ato-l)_pound_=__________________________

Business Telephone-ltN-DiJ--E-=-____________________~___

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 33: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

7 Education Dates Names Locations and Degrees

College

Graduate Studies _____________________________

cnhern _______________________________________

8 List Membership in Professional Societies and Associations _J=w+AtL_____________

9 List complete employment record (up to and including present jobs positions directorates or officers nips) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted Yes No (Circle One) N If

Former employers may be contacted No (Circle One) 0) List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

L)6AJf_

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

pOJ E

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 34: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

I

I

11 a) Have you ever been in a position which required a fidelity bond_-~_D___ If any claims were made on the bond give details ______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked_~AJLltQ~_________________________ I Ifyes give details ______________________________

I 12 List any professional occupational or vocational licenses issued by any public or

governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __IJ)dIllLA__________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked N Q Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

JOvE SUlltf)hf

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school AI Q If yes give details _________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school A- 0 If yes give details

17 Have you ever been adjudged bankrupt ___IloIJultO--_________________

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 35: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knowledge and belief

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment cb3rging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings ofany federal or state regulatory agency rJ (l

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship__--JtJ-D=--_____________

20 Are you now or have you been within the past five years a plaintiff Or defendant in any lawsuit If so please furnish details ___________________

Dated and signed this -jir=--- at S s

I hereby certify under penal

~tlm~~ State of TtyA- 5

Personally appeared before me the above named--___---_~_____--_________--___------personally known to me who being duly sworn deposes and says that helshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this ___-~__ day of mt~l 20 d) ~

My commission expires _______

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 36: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyU1 Member of the governing board of the sponsoring entity ~ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer

State Position as defined in TEC 121012

Fnll Name of Sponsoring Entity

bullIYJIIJtrzzqs nJMtt6 ltiw7lm IUc

Full Name of Proposed Charter School flUmes D7liJuI1I7tbAlIt 5CIocL

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not Acceptable) ampVStt COkE

2 Have you ever had your name changed or used another name t-~OL____

If yes give reason for the change fn=I1RII6e-____________________

bMaiden Name (iffemale) _OWIlNzgt________________________

cOther names used at any time __________________________

3 Social Security Number _______________

4 Date and Place of Birth z OldSO IIritldll Gil

5 Business Address 930 J ftRVELh IgtR ilEa) lbefJiJifkAf Zfd6I

Business Telephone q7 - is[ -0070 X loil

6 List your residences for the last ten (10) years starting with your current address giving

DATES CITY AND STATE ZIP CODE 1111- RiyenoT GIIfMe 11-051

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 37: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

7 Educatiou Dates Names Locations and Degrees

Graduate Studies ____________~----------------

Othe~_________________________________

8 List Membership in Professional Societies and Associations _______________ (ielJlIWUt flJIA42ampe oft1mye

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) ye=

DATES EMPLOYER ADDRESS TITLE

10 Present employer may be contacted No (Circle One)

Former employers may be contacted Yes No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

9fi~~~1 1111 (lmcs ampiOiIIIIltpound tevrIR loakJat2raquo(er]p Siae~

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

same 4S ~bQve

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 38: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

11 a) Have you ever been in a position which required a fidelity bondLtIc0--___ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked-ltM-IoQlt--___________________________ If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)________________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing agency or regulatory authority or has such license held by you ever been suspended or revoked iO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school (IO Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school tiCJ If yes give details

17 Have you ever been adjudged bankrupt --N1~d_____________________

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 39: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

ant)

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency--NO-_____

Ifyes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was Jlaced under supervision or in receivership rehabilitation liquidation or conservatorship~=OO_________________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit tO If so please furnish details ____________________

Dated and signed this_-f-_- day Of_~-L_O_--------- 20 0 shyat ~

I hereby certify under penal ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge

State of _TtJLJL-______

County of pound I(nj

Personally appeared before me the above named---Q~hJ -frltA---C-JJ-L)-----c--_--______C

personally known to me who being duly sworn deposes a~ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this Q b~ day of C1al20 0

bullSii ~

Lou Blanchard NGtIry Pwllc Stall of

Ny COmnjooIoII-shy ~~JJUNE 11 2004 ~~ (SEAL) My commission expires 0 )Ir01

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 40: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyo Member of the governing board of the sponsoring entity 0Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

D School officer

State Position as defined in TEC 121012

Full ~alfe of Sponsoring Entity ~

M () C hclt l( 11k) 0 b o )

Full Name of Proposed Charter School

1 t r ilt2fS 5 hlJ -tn+emzM I

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

I Full Name (Initials Not J Acceptable) fY7a 1 a 0

2 Have you ever had your name changed or used another name I S

rfyes give reason for the change M~M---Iamplaquo(---_--__________________

bMaiden Name (if female) _-lt60(Clt-=--_____________________

c Other names used at any time __________________________

3 Social Security Number

4 Date and Place of Birth -lt7--yen------------~=~lt_c=-----------

5 Business Address -17M drY 0

Business Telephone (rl 7J u ~ ~ 0 21 r 6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE [ - 92 1tt1J 13 Ittdr JiM 1lt5V( 7lkC) 0

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 41: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

~middotfO

7 Education Dates Names Locations and Degrees

College t- 7i- t=- J 7 Ia )

Graduate Studies _______________________________

Others C RW I f4 r A 4

8 List Membership in Professional Societies and Associations ________________

NIgt~

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

No (Circle One)

Former employers may be contacted

10 Present employer may be contacted

No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

7hlV( lt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

(lonG

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 42: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

II a) Have you ever been in a position which required a fidelity bond~O---1J____ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked _______________________________ Ifyes give details ______________________________

12 List any professional occupational or vocational licenses issued by any public Or govemmentallicensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination)J)J-LJfkwr--_____________________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked nO If yes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSAnON

001(11

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school n u Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school If yes give details ---OOi-_____________________________

17 Have you ever been adjudged bankrupt _-lLCltgt-__________________ ~

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 43: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency~Il-LJ()---____

If yes give details ______________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_-Ln---O--______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit f I Ifso please furnish details ____________________

Dated and signed this day of Jv1r 20 OL at Lf eeI JJS 1 to) kid-ltYJUVl til

I hereby certify unb penalty ofperjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

State of ~1A~ (

County of ~-=-C

ofhislher knowledge and belief

Subscribed and sworn to before me this --001----- day Of_lNllgtLoGA-___wQy

Personally appeared before me the above named~-+----7_r_u~__~gt--c________-----shypersonally known to me who being duly sworn deposes and ys that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best

~Q~J4~middotUlT1C)

My commission expires _~-----l_eJ_I___

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 44: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Cheskall that apply ~ber of the governing board of the sponsoring entity ~ember of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Fu~e of Proposed Charter S~ l ~ ampJ0pS laquonO V11

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Nam~iti~Not 0 Acceptable) ~OoJ

2 Have you ever had your name changed or used another name NO If yes give reason for the change _________________________

bMaiden Name (iffemale) ___________________________

3 Social Security Number

4

Business Telepholne~Sl~~_J-~~~~~~~~---------------

6 List your residences for the last ten (IO) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

rtO(q

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 45: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

7 Education Dates Names Locations and Degrees

Others iftfZ(SlL ~wq

8 List Membership in Professional Societies and Associations _________________

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

10 Present employer may be contacted (S)

No (Circle One) Yes

Former employers may be contacted No (Circle One) G

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 46: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

___ II a) Have you ever been in a position which required a fidelity bOnd_~~O If any claims were made on the bond give details _______________________

b) Have you ever been d an individual or position schedule fidelity bond or had a bond

cancelled or revoked_~~---------------------------If yes give details ________________________________

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer oflicense date tenninated reasons for termination) _________________-________________

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or governmental licensing ag~ltJy or regulatory authority or has such license held by you ever been suspended or revokedlO- Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

- 10 rOllpf~SlmO 4~ter shy15 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent

great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any csation or remuneration from the sponsoring entity or the proposed charter school MJ Ifyes give details __________________

16 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compen~~on or remuneration from the sponsoring entity or the proposed charter school ~ 0 If yes give details

17 Have you ever been adjudged ban1aupt _Npo-____________________

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 47: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

_____ _

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you be~esubject of any disciplinary proceedings of any federal or state regulatory agency __-C--O

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder of any business which while you occupied any such position or capacity with respect to it became insolvent or wpced under supervision or in receivership rehabilitation liquidation or conservatorship-I~ualfl________________

20 Are you nnor have you been within the past five years a plaintiff or defendant in any lawsuit ~O If so please furnish details _____________________

~lJu~~bQl3~d~ay~of=~tY~~~2t=======~~~~=~~~2~0=O=2-=~____at - I hereby ce un er pena ofPeDury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowl ge

Stateof ~YL

County of ~AOpoundplusmn Personally appeared before me the above named poundIt 1ult1NJ cl~- )~personally known to me who being duly sworn depos~ath~uted the above instrument and that the statements and answers contained therein are true and correct to the best ofhlslher knowledge and belief

Subscribed and sworn to before me this __-~yen-___ day of~ 4-20deg7 - ~

~~L1_1l----shy~ Lou Blanchard ~) tJ)NOlar~ Dl T8111

My commission expires le - a -J~B1 JUNE 11 bullbull)~

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 48: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPmCAL AFFIDAVIT (MUST BE TYPED and NOTARIZED)

Check all that applyQ Member of the governing board of the sponsoring entity lJ Member of the managing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Sponsoring Entity

Mid-Cities LearnLng Cenber

Full Name of Proposed Charter School

Treetops International SeReel

In connection with the above-named organization and charter school application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

1 Full Name (Initials Not Acceptable) I$aren Kriegler Davi denko

2 Have you ever had your name changed or used another name Yes

If yes give reason for the change --~Ml1iil~rr=iailggfEiO--_________________

bMaiden Name (if female) _____KcJrieqJueJTlt--_________________

cOther names used at any time Karen Linda Kriegler

3 Social Security Number _------------------ shy

4 Date and Place ofBirth -Augu=st--1-9--t9=57_--Om=aha-L--Nebrask=a__________

5 Business Address __--6 --Gpe-vcinei4-_TXC---760S1______0 6-Lal ewood-Lane r a

Business Telephone __817-368-=3S68--____________________

6 List your residences for the last ten (10) years starting with your current address giving

DATES ADDRESS CITY AND STATE ZIP CODE

April 85toopresebt 606 Lakewood Lane Grapevine TX 76051

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 49: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

7 Education Dates Names Locations and Degrees

College Iowa statQ Upj l7Qrsity Ames llpiveJsity oflllexali at DallaS

TOv73

Rmiddot I d fX B~h e1l111 la1lae

I

8 List Membership in Professional Societies and Associations _________________ None other than Elder vp Valley Ridge Community Church RCA

Boy Scouts of America

9 List complete employment record (up to and including present jobs positions directorates or officerships) for the past twenty (20) years

DATES EMPLOYER ADDRESS TITLE

1980_1982 Garland Daily News Garland TX Art Director 1982-1980 Members Life Insurance Dallas TX Life underwriting Sup 198middotmiddotmiddot~990 U~S Life Dallas TX Olstomer SerViCe

1999 IlreseflE Self emIlleyee KareR K gYiaeBkg KKD Designs

10 Present employer may be contacted No (Circle One)

Former employers may be contacted No (Circle One)

List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters

DATES EMPLOYER ADDRESS TITLE

NIlgt

List all previous experience with any charter school management company

DATES EMPLOYER ADDRESS TITLE

Nill

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 50: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

II a) Have you ever been in a position which required a fidelity bond ___N~O~_ Ifany claims were made on the bond give details _______________________

b) Have you ever been denied an individual or position schedule fidelity bond or had a bond cancelled or revoked __~NrlOL___________________________

Ifyes give details ________________________________

NIA

12 List any professional occupational or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past (State date license was issued issuer of license date terminated reasons for termination) __________________________________

NONE

13 During the last ten (10) years have you ever been refused a professional occupational or vocational license by any public or govemmentallicensing agency or regulatory authority or has such license held by you ever been suspended or revoked NO Ifyes give details ______

14 Explain any compensation that you expect to receive from your association with the sponsoring entity the charter school or a management company of the school

POSITION COMPENSATION

NA

15 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO Ifyes give details __________________

16 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the sponsoring entity or the proposed charter school NO If yes give details

17 Have you ever been adjudged bankrupt __JNO-____________________

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 51: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

18 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO

Ifyes give details ________________________________

19 Have you ever been an officer director trustee investment committee member key employee or controlling stockholder ofany business which while you occupied any such position or capacity with respect to it became insolvent or was placed under supervision or in receivership rehabilitation liquidation or conservatorship_IlNIlOL_______________

20 Are you now or have you been within the past five years a plaintiff or defendant in any lawsuit NO If so please furnish details ____________________

Dated and signed this 1rn day of May 20--02_--

at lEeejeps IajerRaliiQaal School Eu ess TX I hereby certify under penalty ofperjury that I am acting or my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

Stateof~p CO~~ of ~ 1 Ii Personally appeared before me the above namedQYlj DaAJId(1 IG() personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hislher knowledge and belief

Subscribed and sworn to before me this _---~_ltZ-__ day of ~ wO~ I

~nl~AL1---_~)

(SEAL) My commission expires i -- - 0 lt

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 52: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Attachment 4

a School Brochure b Pre selection page c Enrollment furms d Treetop is an inclusive school that offers instructional settings for all children in

the mainstream setting Tutorials are offered to all students from 800 am to 830 and 345 to 400 daily Tutorials are optional except when mandated in the IEP Speech therapy occupational therapy and counseling services are provided by a contract service with Mid Cities Hearing and Speech Partners in Therapy and special education needs are met through a certified diagnostician and teacher Services are offered in the classroom when possible Pull out services fur speech occupational therapy and testing are used and are offered in the diagnosticians office for confidentiality All faculty members are apprised ofspecial education and special needs students IEPs and have access to those records Faculty meetings are held every Monday to update information on such students

e Transfer students that receive special education placement the ARD committee may meet when the student registers and parents verify that they were receiving special education in the previous school district or it is verified through writing by the transferring school An ARD committee meeting shall be held within 30 days from the first ARD meeting to finalize or develop a new IEP based on the evaluation data Ifthe previous IEP is acceptable the school has this in writing from the parents then no transfer ARD is required

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 53: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

OUR STUDENTS

Respect for Individuals Respect for ProPltty bull Small Classes -Self-learning expeciencs

Imiddot

~

bull Multi -disciplinary appraches -Range of courses andactiVitieamptJJiandpffE

campus igt -Students are inasaf6enYl()nmeflt and qecom~

self valued learners n

learnillg i ir jllUlillV I

What we discover alollg the Ivav is jusr as importanf as wln we how

whell we arri ve

middotTreetops is located at 12500 South Pipeline Rd in Euless Texas on 20 wooded acres of ettings designed for multiple intelligence earnIng From the DFW Airport take the Airport ~reeway to the West Exit Hwy 157 (lndusshyrial) to the South Turn East on South Pipeshyine Road Jffiee hours are 8 a m to 4 p m ehool hours are 845 a m to

hone (817) 283-177 ax (817) 684-0892

OUR FACULTY

We employ 20 faculty members from varied experiences locations and educational backshygrounds Each is knowledgable in -Montessori -Howard Gardners Multiple Intelligences -Carnegie Basic Skills bullArthur Andersens School of the Future

OUR SCHOOL

Treetops International School is a multi-disciplinary hands-on learning place where parents teachers and the community-at-large join hands to provide the resources experiences and instruction through which each child may excel

Parents ptovide invaluable support to the learning cooperative teachers draw from both old and new philosophies strategies and resources and the community-at-large expands the world of each learner by adding insight from their area of expertise With this collaborative effort children enjoy a learning environment that enriches the present moment gives full recognition to the past ~lds a bridge to the infinite possibilities of the future x~) -Treetops has provided innovative and quality education fur thirty years We are accr~i~dl thr(tgh 12th grade by the Southern Association of Colleges and Schools In addition Treetopsis3lUyenPbecltlf the Texas Independent School Consortium and TANS In 1998 Treetops was ap proved~~~teshyBoard of Education as an Open-Enrollment Charter School of the State of~~bullbull~ j-ltf-shymiddotOur current facilities include an envitonmental complex in the Metroplei ~~~~~~_~~ltfp~nshybuilding a Hostel band room ~ playing fields replicas ofa Native Arne~~K11ii~oiI(s~rt pagodas festival grounds nature tratls and gardens c _

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 54: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

n Treelops=-=3 rr 0 ~

eshy r l

iAJJampXil--2iE$sect eo a Texas State Charter School

gtj -) 0 0 Igtshy0

l

eshy~

~

12500 S Pipeline Rd Euless TX 76040

(817) 283-1771 Fax (817) 684-0892

wwwtreetopsorg

0lt 1=

~

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 55: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

---------------------------

---------------------

---------------

Pre-Selection

Students Name ___________________________

Parents Name

Address _______________________________

Phone Home ______________ Work ______________ Cell Pag~ ______________

EMail

Grade entering into ______

DOB

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 56: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

+ Treetops International School 2002-2003

Child ____________ DOB ____

Address __~------__=-------__--Street Town Zip

Name and relationship ofperson with whom child resides ___________

Home Phone ______ Work Phone _______

Cell Phone ______ E-Mail ________

Emergency Contact ___--____--_____-___ Name phone

Parent involvement agreement We understand that the school is organized as a parentshyprofessional cooperative We agree to fulfill our required 80 hours of annual co-op work responsibilities as designated by our State Charter

Special service agreement We understand that special services provided before or after school are the financial responsibilities of the parents ofparticipating children These inclUde but are not limited to before and afterchildcare private lessons- travel and extra curricular sports We understand that lostor damaged textbooks are the responsibility of the parent and they will be billed accordingly School supplies are not supplied by the school but are the fmancial responsibility ofthe parent

Liability release agreement We release from liability for accidents or injury while at the Mid Cities Learning Center on a school trip in transit to and from field trips or in route to places agreed upon with the school teachers and or advisors We release from liability the Center its advisors the Board ofDirectors the faculty the parents the volunteers and student teachers

WEHAVE READ UNDERSTAND AND AGREE TO THE ABOVE AGREEMENTS AND CONDITIONS OF ENROLLMENT AND TO THE POLICIES STATED IN THE HANDBOOK

SIGNED

Signature Relationship to child

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 57: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Part Two

Treetops International School 12500 S Pipeline Euless Texas 76040 817283-1771

STUDENT DEMOGRAPIDCS DATE STUDEmiddot~N=T~N~AME~~-middot----- shySTUDENT SOCIAL-SECuru=T=Y----------------- shySTREET ADDRESS ______________________________ CITY STATE ZIP________~_____________--____ HOME PHONE E-MAIL ADDRES-=SIB=E=EPER-NUMB-=CER-~-------~----

GRADE JUST COMPLETED ___shyGENDER MALE FEMALE ___ DATE OF BIRTH___________ PLACE OF BIRTH CIRCLE ETHNICITCy--B7--k--H-is-p-an--i-c---Asian Caucasian Native American 1acFATHERS NAME WORK PHONE ____ PLACE OF EMPLOYMENT MOTHERS NAME -----------W~O~RK~P~H~O~NE~------PLACE OF EMPLOYMENT EMERGENCYCONTACTamp~P=H~O~NE=---------------------

RELATIONSHIP DOCTORSNAME-amp~P=H~O~NE~C~O----------------------

MEDICAL INSURANCE CO SPECIAL HEALTH REQUIRE-ME=NT=SIM=EDI~CAL-=---AL---L~ER-G-=IE=S-------- shy

SCHOOL DISTRICT WHERE YOU RESIDE NAME OF PUBLIC SCHOOL CIDLD WOULD=BcE-A-rr=EcND=IN-G--------shy

IS YOUR CHILD ELIGIBLE FOR FREEIREDUCED LUNCH ----77---~___-IS YOUR INCOME UNDER $1650000 _ $16501-$3000 $30001-$50000 _ OVER $50000

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 58: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

LANGUAGE SPOKEN AT HOME CIRCLE ONE

SPANISH VIETMANESE LAOTIAN CHINESE KOREAN JAPANESE FRENCH

GERMAN NATIVE AMERlCAN ENGLISH OTHER

WHAT LANGUAGE DOES YOUR CHILD SPEAK MOST OF THE TIME ___

Are you employed as a migrant worker

Is your child or has your child used Special Ed facilities or had ARD Conferences in his or her school career If so please explain or attach copies ofpaperwork

If divorced who is the managing conservator ofthis child __--____---__

Has your student ever been identified as at-risk for dropping out of school Explain

I certify that all information contained in this document is true to the best ofmyknowledge

Signature _______________ Date _______

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 59: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Part Three

Medication policy The dispensation ofmedication will be permitted when the students health or

continuing attendance so requires and when the medication is administered in accordance with this policy excluding medicated treatments such as nebulizers or wound dressing changes which will be the responsibility of the parentguardian Mid-Cities Learning Center disclaims any and all responsibility for the diagnosis and treatment of the illness of any student as well as evaluation of the effectiveness ofmedication in dispenses under this policy

Action Steps 1 Medication is to be delivered to the office labeled with the childs name date

directions and physicians name 2 Medication will be maintained and secured in a locked box in the office 3 A medication authorization form must be completed by the parentguardian

for the duration of the prescription 4 Medication no longer required is to be removed from the office immediately 5 Non-prescription emergency use medication (for ant stings headaches etc)

may be stored with a medical authorization form stating the specific condition and dosage for which the medicine is to be dispensed

MEDICATION PERMISSION FORM I have read the school policy for the administration ofmedication and give my

permission for the medications listed below to be administered while my child is at school

CHILDS NAME ____________________

MEDICATION amp DOSAGE _________________

DATETIME TO BE ADMINISTERED _____________

PHYSICIANS NAME __________---I-phone _______

PARENTS PHONE DAY --- __________________

SIGNEDBY ____~~~-~~-------------Relations to child

COMMENTS OR SPECIAL INSTRUCTIONS

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 60: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Part Four

Emergency Treatment Authorization and Release Form

TO WHOM IT MAY CONCERN As the parentslegal guardians ofthe child (children) named below

Childs name DOB

We hereby authorize the Mid-Cities Learning CenterlTreetops School International to call for medical care and assistance in the event of injury accident or emergency illness involving our childchildren

It is our intention that this statement serves as authorization for such medical care to be administered Ifit is possible to consult the students regular physician the name and number are

Physicians name phone

Emergency numbers where we may be reached are

Home work

Hospital Preference ______________ Phone _______

Insurance Information _______________________

Group ______ Certificate _________ Carrier ______

ALLERGffiS ____________________________

SPERCIALNEEDS ___________________________________

MEDICAL HISTORYIINFORMATION IS ON BACK

SIGNATURES _____________

Date

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 61: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

All students are presented policies relating to attendance drugs alcohol smoking weapons and asked to make agreements about conforming to the policies as a condition of ongoing enrollment These agreements are reviewed at six week intervals if conditions warrant

The open enrollment charter provides for the exclusion of students with documented histories of criminal offenses juvenile court adjudication or severe discipline problems under TEe chapter 37 subchapter A

My child has never been arrested or convicted of a misdemeanor or felony

Signature __________________ date ______

Explanation if needed

Admission will not be based on gender national origin ethnicity religion disability academic artistic or athletic ability or the district the child would otherwise attend

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 62: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Attachment 5

Electronic Certification

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 63: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Part 3 Electronic Copy Certification and Written Resolution (Attachment 5)

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The electronic copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy must be identical to the hard copies The signatures below are required to certify that the electronic and hard copies are identical

By signing below I hereby certify that the enclosed electronic and hard copies are identical

co -fl-cn Printed Name of Chairperson of Charter Holder Board Signature Date

Printed Name of Chief Executive Officer of the CIuiTter Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter holder and signed by the members voting in favor The resolution must authorize the commissioner to renew the open-enrollment charter as set forth in the renewal application as finally negotiated between the charter holder and the commissioner including any conditions (Attachment 6 Written Resolution)

19

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 64: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Attachment 6

The Board of Directors met on June 10 2002 and have hereby adopted the attached charter school renewal application This gives the commissioner the authority to renew the open-enrollment charter as set forth in the renewal application as fully negotiated between the charter holder and the commissioner including any conditions

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 65: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

DEC-13-2002 0431P FROM TO 15124639560

Renewal Contingencies

1500 S Pipeline Euless TX 6040 81__3-11 Fall 817-684-0892

TEA Special Education M Murrell

Re Treetops School International

December 13 2002

1 When lEP must be in effect II IEPARD team m Parent Participation

I IEPs must be in effect after initial determination of eligibility and educational need development of goals and objectives and placement in the least restricti veenvironment

The review of the students IEP not less than annually to determine whether the annual goals for the students are being achieved

The review of the IEP will address any lack of expected progress toward the annual goals and in the general curriculum of appropriate the results of any reevaluation conducted information about the student provided to or by the parents as described in the review of existing evaluation the students needs or other matters as appropriate

Treetops School understands that a written report of a full and individual education evaluation ofa student for proposed special education services shall be completed not later than the 60th calendar day following the date on which referrals were initiated The ARDIIEP committee shall make its decision regarding students referred for a full evaluation within 30 calendar days from the date ofthe completion ofthe written report

lEPs will be followed by all classroom teachers after being developed by the ARD committees

II lEP ARD Team

The ARD team shall consist of one or both parents at least one general education teacher special education teacher or provider a district representative or adminstratof Also included may be a speech language pathologists educational diagnostician CT and

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 66: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

DEC-13-2002 0431P FROM TO 15124639560

HSOO S Pipeline Euless TX 76040 817-283-1771 Fax 817-684-0892

psychologist Additional ARD members may include visual or auditory professionals vocational education LEP and homebound students also will have representation

III Parent Participation

Determination ofthe Parent will be the natural or adoptive parent of the child a guardian person acting in the place of a parent (grandparent or stepparent with whom the child lives or who is legally responsible for the childs welfare) foster parent or surrogate parent If a parent is identified but is unavailable or refuses to participate in an ARDIIEP committee meeting the school will conduct the ARDIIEP meeting without a parent in attendance if the campus has provided Notice ofARD and the parent has declined to attend or the Cl1lPllS staff is unable to convince the parents that the parent should attend In this case the campus must have a record of i1$ attempts to arrange a mutually agreed upon time and place Parent shall be given a copy of the IEP without charge A Parent may request a conferenCE or an ARDIIEP committee meeting at any mutually agreeable time to address specific concerns about the students special education program The schoollIUJst respond to the parents request by holding the meeting or requesting assistance through the TEA mediation process

Should you need additional information please call me and I will forward this immediately Thank you for your help in getting this cleared up Have a great holiday season

Sincerely

cl~ Lou Blanchard Director

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 67: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

AUG-19-2002 0723P FROM TO 15124639732

12500 S Pipeline Euless TX 76040 817z83-1771 Fu 817-684-0892

Texas Education Agency Renewal Application follow up Special Education Ertha Patrick Anne Hemenway 1701 N Congress Austin TX 78701

Re Special NeedsStudent Program Section

Confidentiality Statement of Confidentiality All information concerning a student with disabilities is confidential and may not be discusses with anyone except those who have a legitimate educational interest in the student with disabilities The list of those persons with legitimate educational interest is posted on me file cabinetsllocked are where special education records are kept Anyone other than those authorized school employees to whom access to the records of the identified student is given must sign the accessibility log The log must include the name of the person the date access was given and the purpose for which the person was authorized to use the records See procedural safeguards forms attached for notice ofparents discipline actions and access rights Each student has individual records in order to eliminate question on multiple records As a Texas State Charter School all services are free and that is stated in the Consent for Initial Placement see attached The opportunity for hearing is defined in the Procedures and Safeguards which is distributed to the parents at the time the referral is made and each time that a notice is sent and consent is requested The result ofhearing is ensured by a final hearing decision that is reached and mailed to the parties within 45 days after the receipt of request for hearing Parent consent is explained in the procedures and safeguards which is distributed at each meeting

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 68: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

RUG-19-2002 0724P FROM TO 15124639732

2500S Euless TX 76040 8s7-283-s77s Fax 8S70684-089Z

Procedural Safeguards

Parental Consent

Access to Educational Records

All infonnation is kept on campus in a locked facility The destruction of information is on a seven-year cycle The procedural safeguards clearly define each students rights Please see attached Treetop is subject to compliance visits from TEA where each individual folders are reviewed Treetop had a DEC visit in October and is in compliance with all special education laws See attached

An independent evaluation if a parent does not agree with the school district they may request an individual educational evaluation to be conducted by a qualified exantiner who is not employed by the students school district The school may at their expense pay for the IEE or they may file a due process hearing to show that their evaluation was appropriate Ifthe hearing officer frods that the school districts IEE was appropriate they may have the IEE but not at the schools expense

Prior written notice is given to parents before any testing or administration ofIEPs in the Notice of Full Evaluation see form attached And the Consent for Full Evaluation and Individual Education at which time permission is given The parent is infonned ofrights in the students native language see fonn attached

All rights are verbally explained as well as given to the parent before any testing or recommendations are made See fonn attached Parental refusal of services must be in writing and is subject to hearing

All special education records are locked and are accessible to parents teachers with legitimate educational interests and related service personnel assessment personnel and educational director Documentation ofentry to the file is required each time of access Records are to be made available without unnecessary delay Information may be

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 69: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

RUG-19-2002 0724P FROM TO 15124639732

inspected only on your child The school cannot

Opportunity to Present Complaints

Initiate due Process

AEP Placement

Private School Students

Mediation

Due Process Hearing

charge a fee to retrieve education records but may charge a copying fee but may not keep a parent from obtaining those records

Parents may file TEA if they suspect violation of state or federal laws in writing Within 60 days of receiving the complaint TEA will investigate and give the opportunity for requesting more infonnation and advise decision Parents have the right the right to appeal to the US Department of Education

See above

AEP placement is made upon recommendation ofmiddot the ARD committee based on the presenting behaviors and intervention strategies that have been implemented in the students current educational placement

Students coming from a private school are accepted if the student is served in a private school the home district would cover the cost of any special education services for which the students are eligible And upon transferring to this school we would have a continuum of services

Mediation services are provided by a neutral third party and made available by TEA The TEA will normaUy offer this service upon request ofdue process hearing The stay put rule (whatever current IEP is in place remains until resolved) is enacted when a consensus during part of the ARD process

Request must be made in writing to TEA because you feel that your student needs special education services or you disagree with the evaluation or you have concerns about placing your student in special education Of related services or you feel that your

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 70: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

AUG-19-2002 0724P FROM TO 15124639732

12500 Euless TX 76040 817-Z83-1771 Fax 817-684-089Z

State Level Appeals

Civil Actions

Attorneys Fees

State Complaint Procedures

Evaluation of children to Determine eligibility

students rights to a free and appropriate education have been violated The request should include a description of the students problem a proposed resolution to the problem and a copy must be sent to the schooL

The hearing officer is final unless a party to the hearing appeals the decisions to the state or federal court

The parent has the right to appeal the findings and decision of the hearing officer to the state or federal court The court must receive the records of the due process hearing hear additional evidence and grant the relief court determines appropriate Due process must be complete before ftling suit

The hearing judge will mandate who is responsible for attorney fees (at reasonable rate) and set the rate for such including cost ofdue process hearings

Parents who feel that any school has violated their studellts federal or state law may file a written complaint with TEA Complaint Management Division 1701 N Congress Austin Texas 78701

See attached forms You assess in all areas of suspected disability and look and informal (teacher observations class work teacher tests parent information health history school history and current school records) and formal assessment (standardized tests curriculum based assessment medical reports psychological reports evaluations provided through related services assistive technology vocational assessment speech and language) results Criteria is based on each eligibility on reshyevaluations you review all previous assessment information both formal and informal and determine

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 71: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

AUG-19-2002 0725P FROM TO 15124639732

2500 PipeUne Euless TX 60408middot283-77 Fax 8-684-0892

if additional fonnal assessment is needed or determination is made through previous assessment that disability continues Eligibility forms attached since they give specifics for each disability Additional teams members could be Administration classroom teachers related services instructional services or other persons or school who could provide additional information Criteria for determining learning disabilities are a group of qualified professionals and the parents who review test and other evaluation materials The committee must determine ifa lack ofprogress is due to the lack ofinstruction in reading or math or due to the students limited English proficiency or does meet other eligibility criteria Criteria needs to include social and cultural background and adaptive behavior The criteria must include childs achivement commensurate with his or her age and ability levels in areas such as oral expression listening comprehension written expression basic reading skills reading comprehension ~thematics comp~gs-EathClllltics reasoningsr Other )

_condItions might include a visual hearing or motor impainnent emotional or mental disorders One

team member must make observations other than the childs regular teacher shall observe the childs - academic performance in the regular classroQm

setting~------------ ~--- shy

See eligibility form attached which addresses whether or not it exits how detennination was made observation of child how disability affects functioning any medical findings does a discrepancy exists and cultural or economic impact

Development amp See attached copy ofIEP which includes month day and year It also states who the IEPARD team is parent identification and agency responsible for transitions services IEP accountability is on the goal and obj ection pages as to who is going to

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 72: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

AUG-lg-2002 072SP FROM

I2S00 S Euless TX 7604bull bull I7-283-I77I Fax1792

Implementation ofIEP ESY

LRE

Services to Expelled Services

implement A student whose behavior has been demonstrated to be a severe threat to themselves or others or property requires a functional behavior assessment and behavior intervention plan which is developed by the ARD committee There is a log on each student for recording each time restraint or time out is required These logs tell when it happened what staff member time of time out or restraint and duration ofimplementation These logs are in place Specific training for restraint will be provided no later than Aprill 2003

All students are considered mainstreamed unless it is determined the student is unable to make satisfactory progress in mainstream placement Placement in a more restrictive environment is determined by the ARD committee and may include additional services The ARD committee determines the appropriateness of the students participation in nonacademic settings and extracurricular activities If students are excluded from any such activity the ARD committee must determine why that decision was made The ARD committee must also determine if there are any anticipated harmful effects that would result from exclusion from those activities Instructional modifications classes with modified curriculum or criteria for expected participation we also offer special education tutorials (resource) and in and out of school suspension with special education supervision

If the student is found to have committed an expellable offense they are excluded from their campus Review the manifestation of determination If the student has been removed

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 73: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

AUG-19-2GG2 G725P FROM TO 15124639732 P858

USOO S Pipeline Euless TX 76040 8~7middotZ83-~77~ Fax 8~7-684-0892

Instructional Settings

Transfer ARD

IDEA

Transportation

from their current placement for more than 10 school days and it is a change of placement we still provide services Determination of setting is determined by court legal or administration

Treetops follows the recommendations of the ARD committee that makes their determination based on data collected from formal and informal sources and looks at the students progress If it determined that the student is not receiving sum benefit from their educational phicement the committee explores alternative options Always keeping in mind the student is to be in the least restrictive environment Treetop assures TEA that the ARD committee instructional arrangement determinations for students with disabilities are based on individual cases not by administrative convenience or charter philosophy Decisions are based on the students best interest academically and socially

Treetops holds to a higher standard than minimum requirements of transfer ARDs All students that are transferring into Treetops will have a transfer ARD A review of assessment may determine that additional assessment is needed before the IEP may be revised Ifit is determined that current assessment continues to be appropriate the IEP may be updated if determined by the ARD committee

Treetops International School assures TEA that we provipe in good faith free and appropriate public education to all students in keeping with the Special Education Rules and Regulations as outlined in the Individuals with Disabilities Education Act

If a student requires special transportation in order to benefit from their educational opportunity Treetops will contract with a public transportation provider to meet the needs ofan individnal student

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 74: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

RUG-19-2002 0726P FROM TO 15124639732 P958

usoo S PipeUne Euless TX 76040 87z83-77 Fax 87-684-o89Z

The following changes have been made to the treetopsorg web page

Treetops International mission is to enable each children to climb to heights that are their own~

Assessment amp Transportation Q amp A on-line

Student achievement is reported every nine weeks Grades 3-12 will administer the TAKS TAAS SDAA or LDAA or a locally developed test in the spring

A copy of the new brochure is attached

Should additional infonnation be needed please advise

Sincerely

Lou Blanchard

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 75: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

t - bull~ shy0middot1

1

ir I

II ii

I i

IIIirlU EJ]UpoundpoundttELEpoundampLpoundLl11LIiampl1 iiH_~

SPECIFIC CURRICULUM ADMINISTItATIOB RATUlUS

lou BlaruhanI M EdOircctoofCounsclorTelW Essential ~ It Skills M CoIIew MiiclJellLOIver School Coordinator Advanced Plaremenl courses oIfered Ms Beth FO$CrbullMhldlc School Coordinator i

Mr MiIuo KunkeIUppcr School CoordinatorPremiddotAP courses offered Ms leWgt 1hoob_AltcndcltIIEIMS Coolinator FUle Arts Programs SbcUt Moyers Adminitrntive Assisant I l1alld Dclyutollcnl

Dr Deprtmellt

Art DeJllUUncnt 11 ~

Emplmisoo l COllllllunily Service SCHOOL FACTS

Cooperative Leaning TyJlc Public ar School since 1997 HisIOQFounded as a Private School in 1969

GrndcsKtllfougll2 TDIaI EmolhncnL 7 340

Trutops JtIIiolUllSclloo Ibullbull mulddlsolplimiddot nary hltlldJoo lelFDlnc Wiler wbre pareDlS tehen artd tbecounllyatargej band t provide Ibe remrees elpcrlrDteland In uctlo tIlrelJlh wltlcb a bUd 1 dlmb to tbe heights lbbullbull are eJr own

Flrenb provide SUpporlnn1te1llJthe Jund0l eooperanft tuum draw from hoth old and dew pb1l0lOpklHIIralqies aod resourceSj and ACCREDITATIONtbe commuRltyt-large tlplndl the world or nth eaner by addlne to the rltbDess rrom heir area or expertise From bl collabarltive rTreltlop is accredited by d TeJI Educallooi Aicney aivl errort comes IUIIlblg untroneat lbit eDshy de SoudlCm Association ofSecondary Schools and Colmiddot rich the pt IDOmD~ e1vesluU recognishy Icampes lion 0 tile Plst ud bridges Into tbeeblldl I yet undenned fplure

11

J)i

II~~=~= -~-~-=----~ _~oli_~=- =-~ ~l- == ~~~~=~~_~gt--=--=ICI~~=-ll-=~-= -

D

G)

1

I

shyC

ltD ru

re

TREETOPS ~

NTERNATIONAL ~

~ SCHOOL

Adniltslon wal not he bd on gend nolIonaIlrigia lllmlcir rolitiian Isability atBdemit artistic athlelic bait arlhe dialrCt thedtikl Wllld

Ihortteod

I ~ jj

~ ~

11

IIlIamplabliJJg eacJl student to cmilb to dIe

-ltJ1CiglJts l1N1laJe l1~ir OIFlIbull o

VITreetops Intltmational School ISO ~ ~ I

12500 Sliloeline Rd IiEuless TX 76040 ~ (817) 283-1771

wwwmiddottreetopaOIJ l 1

Enj~

i~I ~ U

(JJ- J1 shy

~ m

bullbull=~==--==-~=-=-gt-L=~=~==-=I ltI

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 76: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

P1V58TO 15124639732 AUG-19-2002 0727P FROM

TREETOPS HIGHSCHOOL GRADUATION REQUIREMENTS

GRADE POINT AVERAGE A studes gnule-poinl average is determined by IliIgrade points accumultzted from courses laken for high

school credit

DISTINGUISHEDSTATESUBJECT AREA REQUIRED RECOMMENDED ACHIEVEMENT

4 Credits ENGLISH 4 Credits 4 Credits (Including AP)

3 Credits 4 Credits 3 Credits (Algebra 1 amp II Geome-MATH (Algebra 1 amp II Geomeshy(inc Algebra I) try Pre-CalculUs)

3 Crdlrs

try)

3 Credits 3 Credits - (Integrated Physics amp(Integnted Pbysics amp

SCIENCE (Inc I from Biology Chemistry Biology ampChemistry Biology Chemistry or Physics) AP Biology)

4 Credits

Chemistry or Physics)

4 Credits (World Geo World Hist

4 Credits (World Geo World(World Geo World SOCIAL STUDIES Hist US Hist AP US

nomics) US Hist US Gov amp Eco- Hist US Hist US Gov

amp Economics) Gov amp Eyenonomics)

HEALTH 12 Credit

PEATHLETICS

112 Credit 12 Credit

112 Credits

1 Credit

112 Credits 1 112 Credits

1 CreditTECHNOLOGY 1 Credit (Computer Science I or(Computer Science I or (Computer Science I Or II)APPLICATIONS ll)ll)

FINE ARTS ] Credit 1 Credit 1 Credit

FOREIGN 3 Credits LANGUAGES

None 3 Credits (must be same language) Required (must be same language)

SPEECH 1 Credit 1 Credit 1 Credit

ELECTIVES 3 Credits 5 Credits Credits

TOTAL 24 Credits 26 Credits 26 Credits

CREDITS

In addition to credit requiremeots studeots must sbow mastery on the state EXIT LEVEL TAKS TESTS

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 77: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Renewal Contract

May 7 2(03

To The Charter Holder ofTreetops School International Charter School

Subject Charter Renewal

I am pleased to inform you that the charter renewal is approved for Treetops School International Charter ~chool for a term often years with a contract ending date of July 31 2013 After renewal the contract for charter shall consist of the following

bull t~e representations and assurances made by the charter holderin the original request for rpplications under the standard application system

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 adopted or ratified by the State Board of Education or the commissioner

bull middothe final and complete renewal application on file with the Division of Charter Schools ncluding any revisions required by the agency in such areas as Legal Special Education Financial Audits and the Division of Charter Schools including any amendments to the harter made via the renewal application

bull conditions as described in the attached document Exhibit I and

bull all statements assurances commitments and representations made by Charter Holder in its application for charter attachments or related documents to the extent consistent with the aforementioned

Note that 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 By continuing to operate past the ending date of the original charter the charter holder indicates its agreement to the conl ract for charter as described above

Please lnow that the efforts of those who have contributed to the schools successes are appreci ated I look forward to hearing of the schools accomplishments in its new term Contact Ertha Patrick in the Charter Schools Division 463-9575 with any questions about the renewal process

Sincerely

Felipe Alanis Comin ssioner of Education

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation

Page 78: Please review TEC §12.l012 - castro.tea.state.tx.uscastro.tea.state.tx.us/charter_apps/content/downloads/Renewals/22080… · The Renewal Application is due to TEAiCharter Schools

Exhibit I Conditions ofRenewal for Treetops School International

The charer renewal for Treetops School International is approved with the following conditiolls

bull Treetops School International for the next two annual audit reporting years shall sllbmit its financial and compliance report (ie the audit report) on or before the filing due date (currently set at 150 days after the end ofthe fiscal year or January 28)

bull lle agency shall continue to monitor findings identified by the independent huditor in previous financial and compliance reports The agency shall aJso leview future financiaJ and compliance reports and monitor any additionaJ issues identified by the independent auditor

r the agency believes a condition has not been met it may report the matter to the ommissioner In that event Treetops School International may request a limited [learing before the commissioner or commissioners representative solely on the question of whether conditions were met On final determination that a condition was not met the commissioner may consider appropriate administrative action including revocation