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Res 16-02 WA Authorizing the filing of the Charter Renewal Application
WESTLAKE ACADEMY RESOLUTION 16-02 A RESOLUTION OF THE WESTLAKE ACADEMY BOARD OF TRUSTEES AUTHORIZING THE FILING OF A CHARTER RENEWAL APPLICATION WITH THE TEXAS EDUCATION AGENCY. WHEREAS, the Town of Westlake was awarded a charter by the Texas Education Agency to own and operate Westlake Academy; and, WHEREAS, the Charter will expire in 2016 thereby necessitating the submission of the Charter Renewal Application; and, WHEREAS, the Board of Trustees have reviewed the renewal application and finds that it appropriately reflects the information required by the Texas Education Agency; and WHEREAS, the Board of Trustees finds that the passage of this Resolution is in the best interest of the citizens of Westlake as well as the students, their parents, and faculty of Westlake Academy. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF WESTLAKE ACADEMY: SECTION l: That, all matters stated in the recitals hereinabove are found to be true and correct and are incorporated herein by reference as if copied in their entirety. SECTION 2: That, the Board of Trustees Westlake Academy, hereby approves the Charter Renewal Application for Westlake Academy, attached to this resolution as Exhibit "A". SECTION 3: If any portion of this resolution shall, for any reason, be declared invalid by any court of competent jurisdiction, such invalidity shall not affect the remaining provisions hereof and the Council hereby determines that it would have adopted this Resolution without the invalid provision. Resolution 16-02 Page 1 of 2 SECTION 4: That this resolution shall become effective from and after its date of passage and furthermore authorizes the submittal of the Charter Application to the Texas Education Agency. PASSED AND APPROVED ON THIS I1th DAY OF JANUARY, 2016. Y44a� _ � Laura Wheat, President ATTEST: Kelly tdward ), Board Secretary Thomas E. Brymer, pe ntendent APPROVED AS TO FORM: Janet, . Bubert or L. Stanton Lowry, School Attorney Resolution 16-02 Page 2 of 2 s � � OPEN - ENROLLMENT CHARTER RENEWAL Contract end date: July 31, 2016 Petition due date_ January 5, 2016 ��� T¢xas Etlucaiion Ag¢ncy - - ExPlanation of Renewal Process.....................................................................................................................................4 Application Instrtrctions.....................................................................................................................................................................5 SelettetlDefinitions........................................................................................................................................................6 Application Sections: SectionI.Cav¢rsheef(Attachment A1..................................................................................................................7 This is a printout of current charter holtler information from the TEA Division of Charter School Administration database,the CSTS,antl must be attached as the application coversheet[Attachment A). SectionII.Contact Information.............................................................................................................................g Requires She charter holder to provitle the current contatt information for the superintendent, the charter holtler board chair,and the person who pr¢paretl the application. SettionIII.Website Postings..................................................................................................................................9 Requires the charter holder to provid¢the homepage web address where th¢names of the members of the governing body are listed; the web address where the superintendent's salary is postetl; and web atldress where the charter financial statements are continuously posted as required by Local Government Code §140.006. Section IV.Organizational Charts........................................................................................................................10 Requires the charter holtler to provitle the organizational chart of the charter school as well as a chart showing other entities and programs managed by the charter holder. This section requires the submission of attachments 1 and 2. SectionV.Atlmission PoIICY................................................................................................................................ 11 Requires the charter holtler to provide tle[ails concerning the charter school's atlmission policy antl prattices. In atltlition,this section requires the submission of attachments 3,4,antl 5. Settion VI.6Pecial Education Assurances...........................................................................................................14 Requires the charter Fold¢r to certify that it has policies antl procedures In place that ensure implementation of all federal laws and regulations,Texas laws,State Board of Education rules,antl commissioner rules related to students with tllsabili[ies, and further assures that any future amendments to th¢ regulations, laws, and rules will be incorporated and implemented.This section must be signetl by the charter holder board chair. Section Vll.Serving Students ai R¢sidentlal Facilities Assurances......................................................................15 This section is required only when the charter educates rtudents at a residential facility. Requires the charter holder to certify that it has policies and procedures in place that ensure implementation of all fetleral laws antl regulations, Texas laws, State Board of Education rules, and commissioner rules related to charter schools serving students at residential facil fries and further certifies that any future amendments to the laws, regulations, and rules will be incorporated antl implemented. If requiretl, this section must be signed by the charter holder boartl chair. Section VIII. Bilingual/E54 5¢ction 504,and DYslexia Assurances......................................................................17 Requires the charter holtler to certlTy that (t has policies and procedures in place ensuring that it complies with the legal and regulatory requirements concerning identifying and providing appropriate education services to limited English proficient students, students protected by Section 504 of the Reha bilitatlon Act of 1973, and students with tlyslexia or related disortlers. This section must be completed and signed by the charter holtler board chair. - - Section IX. FingerPrinting antl Criminal Record Check Assurance....................................................................18 Requires the charter holder to certify that it is in compliance with TEC §12.120, and confirms that no individual Is serving in any capacity if he or she has been convict¢d of a misdemeanor Involving moral turpitude; a felony; an offense listed in TEC §37.007(a)� or an offense listed in Article 62.001(5) Code of Criminal Procetlu res; unless the individual is eligible to be employed in a position In a school district under TEC§12.120(a-1). Section X.Certificate of Acknowledgement.....................................................................................................19 Requires at least a majority of the governing body of the charter holder to certify that it has hatl an opportunity to review the completed renewal application and has authorized, during an open meeting, submission of the applicatign to the commissioner of education for consideration of the renewal of the charter. Texas Education Agency Contact Information................................................................................................20 RenewalProcess Flowchart..............................................................................................................................21 Attachments Requir¢d of AppRcan[: Charter School Organizational Chart(Attachment 1) Charter Holder Organizational Chart(Attachment 2) Admission Policy(Attachment 3) Admission Application(Attachment 4) Enrollment Form(Attachment 6) • • • � � � • e 39 Texas Administro[ive Cade(TACJ g100.1031 contains additional information about charter renewal. The r wal process i eparate from the charter amendment process. Significant changes from th¢ original charter should not be made in the renewal application unless a charter amendment has been previously approved. As authorized in Texas Education Code(TECJ g12.1141,the commissioner's procedures for renewal must Include three distinct processes:expetlitetl renewal,discretionary renewal,and expiration. Definitions of the three renewal processes: If In the nrecetlin¢3 years: •Highest or second highest academic performance rating •Satisfactory or higher financial rating;and .No campus has been assigned the lowest rating or such a campus has been closed Consideration amone others of: •Acatlemtc Ratings 2O1D-2011,�Bi3-2B32,2012-2013,2013-2013, 2014-2015(no ratings issued in 2D31-2012) • Financial Ratings 2010-2011,2011-2D12,2032-2013,2013-2014,2014-2015 �j� • Performance Framework(TEC§32.31g1) t`✓/I If for any 3 of the 5 nrecedine school years: •Lowest academic performance rating •Lower than satisfactory financial rating •The charter was assigned any combination of ratings,or •A campus has been assigned the lowest pertormance rating for the 3 preceding school years and has not been closed The due date for charters io submit the completed renewal application to the Texas Education Agency(TEA)is 7uesday.January 5. 2016. You may request an assessment of the renewal designation ascribed to your charter above(indicatetl with check mark) by sending a written request to: Brandon 6penrath, Program Specialist Charter School Administration(Texas Etlucatlon Agency 1T01 North Congress Ave. Austin,Texas TS701 Fax(512)936-92g1 brandon.spenrath @tea.fexas.gov The request must be received no later than Tuesday. D¢c¢mb¢r g.2015,Vour request must identify what designation you are requesting,the reasons for your request,and documentation to support your request. If we do not receive your request before the deadline,final action will be[aken without further review. • . . The ren¢wal application contains ten sections to be completed electronically,printed into hardcopy form for required signatures and dates,and submitted on or before the due date to the Division of Charter School Admin tstratlon. 1.D¢adllne:The completed application must be returned by mall to the Division of Charter School Administration by: Tuesday_lanuary 6. 2016 2.Typing Requirement:All of the responses to the application sections,with the exception of signatures and dates of signatures,must be typed. 3.Printing Requirement:The application must be printed on one-sided 8 1/2"x 31"white paper. 4.Signa[ure Requirement:Where signatures and dates of signatures are required,they must be in blue Ink. s.Submission of Original Document and One Copy:The c mpleted antl unbound(rubber bands or clips are acceptable) original renewal application,including tillable forms and attachments,and one additional copy must be submitted as follows: Texas Education Agency Division of Charter School Administration 1701 North Congress Avenue Austin, Texas 78701 - - - . � - Please review TEC§22.1022 and 19 TAC§300.1001 for definitions of terms which are available at the education laws and rules page.Listed below are selected terms and definitions: •Chor[er ho/Der-the¢ntity to which a charter is granted under TEC Chop[er 12 • Chpr[er schoo/-a Texas public school operated by a charter holder under an pp¢n-enrollment charter granted by the commissioner pursuant to TEC§12.101 • Govern/ng body of a charter ho/der-the board of directors, board of trustees, or other governing body of a charter holtler • Governing body of a charter school-the board of directors, board of trustees, or other governing body of an open- enrollment charter school;the term Includes the governing body of a charter holder If that body acts as tree governing body of the open-enrollment charter school • Management company- a person or entity, other than a charter holder, that provides management services for an open-enrollment charter school • Officer of o charter school- the principal, director, or other chief operating officer of an open-enrollment charter school; an assistant principal or assistant director of an open-enrollment charter school; or a person charged with managing the finances of an open-enrollment charter school •Boord choir or choirp¢rson-generally the board president or presiding officer of the governing board • - - - ATTACHMENT A:OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL Emailed to you was a document entitled ATTACHMENT A_RENEWAL COVERSH EET which will serve as the coversheet when the application is mpleted and submitted. It includes current information (based on October 2015 snapshot data)in the ChaKer School Tracking System.Verify the accuracy of the information on the coversheet and,if updat¢s to the information a needed, create a separate sheet tletalling your corrections and label the sheet "Update to Data Provided by TEA",and include it in the renewal packet immediately following the preprinted coversheet. The coversheet and corrections document(tf applicable) should be printed and inclutletl in the application just before page 8 when submitting. SAMPLE COVERSHEET OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL COVERSHEET Cvrrnn!Infwmrtlen In CA�,far 4M1ae1 TaeklnCEMdn nuan ssxeu ceunq/m�u��. �wfrtm' •owx.xa_aas Attachment A OPEN-ENROLLMENT CHARTER CONTRACT RENEWAL PETITION Section 1. Current Information in Charter ScFtool Tracking System Charter Holder Name: TOWN OF WESTLAKE Charter School Name: WESTLAKE ACADEMY CHARTER SCHOOL MissionNision: The Westlake Academy will provitle a rigorous curriculum that is international in scope with nigh expectations by snaring the responsibility of educational development between teachers, parents, community, and students. This will be achieved by provitling an innovative approach to education that focuses On each student's needs to develop a thirst for knowletlge, produce positive esteem, encourage good citizenship and maximize their individual potential. This will prepare students for a rapidly changing environment that is global in scope. Charter School County/District#: 220-8'I O Generation: 07 Maximum Approved Enrollment: 1,450 Grades Approved: K,9,2,3,4,5,6,7,8,9,10,t t,t2 Campuses/Additional Sites: 1/1 2208t0001 WESTLAKE ACADEMY 2fi00 J T OTTING ER RD WESTLAKE, TX]6262 Grade Levels Currently Served: KG,01,02,03 04,05,06,0],08,OO,t0,11,12 220810001-Site 2 WESTLAKE ACADEMY 828 Hanivood Rtl Hurst,TX]6054 Gratle Levels Currently Served: KG 01,02,08,04,05,06,0],08,09.10.11.12 Geographical Boundary: The original charter application and amendment history reflects that the following districts) comprise the charter school's geographic boundary: ARLINGTON ISO DUNCANVILLE ISD LAKE DALLAS ISD AZLE ISD EAGLE MT-SAGINAW ISD LEWISVILLE ISD BIRDVILLE ISD FORT WORTH ISD LITTLE ELM ISD BOYD ISD FRISCO ISD MCKINNEY ISD CARROLL ISD GARLAND ISD NORTHWEST ISD CARROLLTON-FARMERS GRAND PRAIRIE ISD PARADISE ISO BRANCH ISD HURST-EULESS-BEDFORD ISD PONDER ISD COPPELL ISO IRVING ISD SPRINGTOWN ISD DECATUR ISD KELLER ISD WEATHERFORD ISD DENTON ISD KRUM ISD Attachment A Update to Data Provided by TEA Update#1- Westlake Academy no longer holds any school related business or activities at^Site 2^ (828 Harwood Road Hurst,TX 76054J. Please update our campuses/additional sites to indicate this change. Update#2- Per communication with the Commissioner of Education on April 18, 2008, Westlake Academy's geographical boundary changed to also include Argyle ISD and Highland Park ISD. Additionally, Grapevine-Colleyville ISD was listed in our original charter but is not listed on the cover sheet - Attachment A TEXAS EDUCATION AGENCY VOI NotW Coepre_aA.#Avatlsy 9bxu 98901_3494f S1]J463.9034#FAX:S1?l46]-9838�pttpl/www.meatnm.u.vs August 7,2067 Waiver ID#2450T Ms„Barbara Brizuela, Head of School Westlake Academy ' 2600 Ottinger Road Westlake,Texas 76262 � Dear Ms_ Briauelac ' � � 1'.received.your eortespondene� dated June 25, 200T, pertaining to the denial of your waiver ' - r-aquas[. After careful review of thFs Ind NitlL81 case. 1 would fike fo inform you that your request ' 'for a walJar bias been 9ra^tad. In addition, your request to change your geographic boundaries ' �' ta�incwda only the school distncta of Blydvlga, Cartell, Grapevine-Colleyville, Keller, Lewisville. and=Nort_tfwas[ has also been granted by the Ghief Deputy Commissioner. This amendment i8 _ effective August's 6, 2007. Sincer Aorain o son, Ed.D. _ ' Assaci Commissioner Cc: Robert Soott Judith De to Garza Mary Peny Jim Davis Attachment A - �YESTLA KE ACA.DFMV - - .. - - - - RESOLIt'I'YON NO. ll$-t14 ... -. A RESOLUTION OF THF. BOARD OF TRUSTEES OF WF.STLAKF_ ACAUEMY- AUTHORIZING AN EXPANSION AMENDMENT TO THE N`ESTLA KE AC:A UEMY CfHARTER TO INCREASE THE C:EOCRAPHIC BOC)NDAI2Y FOR TRANSFER STUUEN7:S. VV.H EREAS- the Board of"1'nxstees desires to expand dte: geographic area from which it >vill accept stude-nt arar>sf i•ca: and WFIE RL•A5. the Board of Tntstecs t7nds [hat the passage. of this Resolution is in the best i ntcrrst of the Academy- ' NOK', "CHEl2EFC>RE, BE IT RESOLVED BV "I'HE HOARD OF TRCBT6F'S OF �1'FSTLA KE ACADE?�TY: SL-C"TiON 1- "I1>at the Board nt 'i-rustees of W"estlakc Acadc my hereby adopts [he Application for C'hartrr Amendnvem attached hereto- Ankle VII- Sc-c tic>n A Geogrtphir _ Baarttdari rs. Ptuagraph 3. to add the fbllo>ving school districts l?om which transfer students will - be accepted: HEB, Decatur_ Paradise, Bayd. ltieathorford. (Crum. Ponder. 17enlon, Litile Elm. Argyle. Frisco. Carrollton. Grand Prairie, E:)uncanvilie. Lake Dallas, Spring own. Azle, C'uppelt. &wing.Arlington- Fort W`ordv. Eagle Mdunfain-Saginaav_ E-fighland Park. Garland. McKinnrv- SPCT7 N >. That Chis Resolution shall become efTective upon [he date of its passage but rontingeut upon approral by tl>cu TEA PASSED AND APPROVE-D ON T>iiS 14i° DAlolC}C)�F,J�ANli�A�R Y"- l)08�. Scon Brvdlr)! Prestdcnt .-�-1-R9S7': f� % r ' ,.. - •Ki Su�.S r[ar `J arba�Brizurl a, He d of School A PPRCIV _�AS 7'4>"PO RhT: �� �Y=�� � L. Stanu> +' S� al Attomry Attachment A Westlake Academy Charter Am¢ndment Request Current Charter (with approved r¢vision dated August I5, 2007) reads: Section I Cover Pae¢ Geographical Boundary: The original charter application and amendment history reflects that the following districts) comprise the charter school's geographic boundary: Birdville ISD Carroll ISD Grapevin¢-Colleyville ISD Keller ISD L¢wisville ISD Northwest ISD Requ¢st¢d amendment would read: Geographical Boundary: The original charter application and amendment history reflects that the Following districts) comprise the charter schoo]'s geographic boundary: Argyle ISD Grapevine-Colleyville ISD Arlington ISD HEB ISD Azle ISD Highland Park ISD Birdville ISD � Irving ISD Boyd ISD Keller ISD Carsoll ISD Krum ISD Carrollton ISD Lake Dallas ISD Coppell ISD Lewisville ISD Decatur ISD Littie Elm ISD Denton ISD McKinney ISD Duncanville ISD Northwest ISD Eagle Mountain-Saginaw ISD Paradise ISD Fort Worth ISD Ponder ISD Frisco ISD Springtown iSD Garland ISD Weatherford ISD Grand Prairie ISD Attachment A ,t TEXAS EDUCATION AGENCY 1]OI Nnnb Cancroaw Avp.f Austin.Tesun]N]OI-IJl4 4>12/J6i_y]39 f FAX:512/-0(3-9%iy f MLLp://ww�w.lcvslvlc.ln'.ux Robert Scott Commissioner April 18,2008 Bevbara Brizuela WesHake Academy Charter SNlool 2600 Ottinger Rd Westlake,'1'X 76262 Dear Ms. Brizuely: The commissioner has approved the amendment request (047-08)to add the following school districts to the charteYs geographic boundary from which transfer studenrs will be accepied: 1-IIvst-Huless-Bedford ISD, Decatur ISD, Pttmdisc- ISD, Boyd ISD, Weatherford ISD, Krum ISD, Ponder ISD, Denton ISD, Little lam ISU,Argyle ISD, Priseo ISD, Carrollton-Parntc-rs Branch ISD, Grand Prairie ISD, Duncanville ISD, Lake Dallas ISU,Springtown ISD,Azle ISO, Coppell ISD, Irving ISD,Arlington ISD, Pott Worth ISD, Eagle MPSaginaw ISD, Highland Yark ISO, Garland tSD,and McKinney ISO effective June 1,2008. Ifyov have any questions,please contact the Division of Charter School Admin is[ration at(512)463A575. S inc�crely�,.^L - > �� Mnry Perry, Diractor Charter School A<Im in istrrn ion • • • • The persons listed below will be contactetl by agency staff if there are issues to be resolved in any of the r wal application sections. Note that any contact information, including email addresses, providetl with the renewal application will be public information. Superintendent's Name: Thomas Brymer Telephone Number: 8t>-a30-09at ext 5>20 Fax Number: 81>-430.1812 E-mail Address: TBrymer®westlake-tx.org Board Chair's Name: Laura Wheat Telephone Number: 8v-a3o-o9ai Fax Number: Bl>-430-1a12 E-mail Address: LWheat®westlake-tx.org Contact Name: Jennifer Furnish Telephone Number: 81>-490.5>62 Fax Number: at>-a9o-5>sa E-mail Address: JFurnish@westlakeacatlemy.org Web Address: http!/www.wes[lakeacatlemy.org/ • - � - � • • in accordance with the requirements of TEC 412.1212, an open-enrollment charter school shall list the names of the members of the governing body on the home page of the school's Internet website. Provide the exact Internet URL address where the names of the members of the governing body are Ilsted. http://www.westlakeacademy.org/apps/pages/Index jsp?uREU0=3161]O&type=d&pREC_1�=56]360 In accordance with the requirements of TEC§32.Z36, an open-enrollment charter school shall post the salary of the school's superintendent or CEO on the school's Internet website. Provlde the exec[ Internet URL address where the superintendent's salary is posted. Please see Attachment B-directly behind this page In accordance with Loco/Government Code§240.006,an open-enrollment charter school shall post continuously on the school's Internet website the annual financials of the school. Provlde the exa Internet URL address where the annual financial statements of the charter school are continuously posted. http://www.wesilakeacademyorg/apps/pages/index jsp?type=d&u RE�IO=3l 6120&pRE�10=86R l O6 Attachment C December 9,2015 Question regarding-TEC subsection 12.136 Jennifer Furnish, Student Services Administrator for Westlake Academy, spoke with Mr. Brandon Spenrath regarding the posting of the Superintendent's salary. The superintendent for the Academy does not receive any monetary compensation for his duties in this position_ The Charter is held by the Town of Westlake and in his capacity as the Town Manager, he also serves as the superintendent for the school. Per the conversation with Mr. Spenrath, he advised that we would not need to post the superintendents salary on the website as long as none of his compensation is paid via state funding and his compensation is not dependent on his duties as the superintendent, but rather his duties as the Town Manager. • • • • Submit, as Attachment 1, the organizational chart for the charter school that specifies [he administrative positions including the title antl name of the Intltvidual currently in each position. Submit, as Attachmenx 2, a chart that itlentffies all other entities under the direction of the charter holder.This would include entities antl/or programs that the charter holder governs/manages in addition to the charter school. If the only entity under the direction of the charter holder is the charter school,submit this attachment as an explanation of such a scenario. Submit each attachment behintl this page of the application. attachment 1 • � Aammry g¢ama ---- -g g � —_.�_ _- cnmmate¢a row .�aen� AKomey Housing Ptlminb[ n[em I Town SecrMary 1 Azs[Ptlnuc Pal/ Athletic � M.q thak Communlcation5 nTm aClerk t .' - I I_ t 5[utl¢nS Servims Atlminls[rat — - Fecili[Ies Malnt¢nance aaae 61 /Parlcz&RHVe9tlon w mISbX rt Cy.b FbH GnIB( xmae u u I an I ert me Oerk I - f euLenmu PYP Prlmiry a u Plannln6 6 PtlndPal m nRezoHrce T�e� I I ve.,erovment/ roe.mn.[a. Hmm�g maPeaor f� MR Geneolx[ - I Guunzelo. Pub11c Wdkz Inf¢rma[lon � TaedM1 a r Technology FIOHPCe I L e^ I Llbensn c tic I � Ez¢cutive[OIrHc[Or' MYP PdnClpel W.A.FounCanOO Police SetWCes I<uz[omea Service b Lmmrva[.e.mv �[ry,¢ My sHPea.laor I A,.ann b«n I . ,�w[ �— ratleme � MYPT.acH.n vP vnnclPal may-+ "e�,� coowlnaor ,. i Exemplary Governance { { Town Officials,Both Elected and Appointed,Exhibit Respect, Telacn®.. � Stewardship,Vision,and Transparency cones. ;'.. f Service Excellence men la. ~r- Public Service that is Responsive and Prafesslonal,wh(le balancing Efflctency,Effec[tveness and Financial Stewardship Attachment 2 Aa..lzory e¢aroz �-_ •.- _. � � ctlmmin¢¢: Town T¢aaS stutlent Attomry MOuslnB �� ntem TOwp$ecletary _ Asst Pllndpal/ —_ Athletic Dbe apuN Oaak I Cpmmunlcallonz ` rYne l P<le.k ___ � ea sae Iona stnaam sam«s marnal Aaminlat.ator `-- Fadlltles Maln[¢nanca A /parks 8 fl¢creatlon 5 aH , o CIe 1 FIIe CM1lef - Nmaa court luQe I wnr«nn¢�an � =n me er f u �� 11 pYP Pllmary 3 Ye a,rcz � Pantlpal �lan�ng a£ human wemu.e¢a >ITE n�nyn®nl D¢.,¢In� a.a r- ala I smlmns m:p¢txol coo.m.am. flean..alnt a.sP Pr weaanw .amemra � �¢n..rar public Works ^ao'ary I nTOrmatlon reaches Tacnnplpgy Flna.c¢ «nnwl.n ue.an.n nam, Executive Dlrettor MYP PnndPal Polic¢5¢rvkM � W.A.FounWOon �� ua � Aoeemlt � ...P T¢atna,a op Pr1nc1Pa1 CaoWlpa[01 �,-+ Exemplary Governance > Town Officials, Both Efetted and Appointed,Exhib(t Respect, Teach � Stewartlshlp,Vision,and Transparency as Service Excellence taaa,ela. �~~� �`-"c~ Public Service that Is Responsive and Professional,while balancing EfFlclency,Effectiveness and FlnanGal Stewardship • • � • � • Please be aware that any change to the terms of an open-enrollment charter that relates to the following subjects: grade levels, maximum enrollment, geographic boundaries, approved ca mpus(es), approved sites, . relocation of campus, charter holder name, cha rter school(district) name, charter campus name, . charter holder governance, articles of Incorporation, corporate bylaws, management company, admission policy,or the educational program of the school requires the commissioner of education's approval of an a endment (See§100.2033(6J Types of amendments,19 TAC Chapter 100.) A.Specify the period during which applications for admission are accepted. TEC;412.117 requJr¢s that a charter schoo/ estab/!sh o reosonab/¢opp/!cation dead!/ne for the submission of app/icotlons for admission. Beginning of Period(Month/Day) End of Period (Month/Day) l2/t l/3t B,If the school admHs students by lottery when She number of admissions applications received exceeds the number of available spaces,describe the procedures followed in conducting the lottery. Q Lottery not utilized If there are more eligible applicants than available spaces in a grade,admission shall first be offered to eligible applicants residing within the primary geographic boundary.After consideration of all eligible applicants from primary geographic boundary,the Acatlemy may admit eligible transfer applicants residing within secondary geographic boundary. If the mbar of applicants from[his boundary exceeds available space,all eligible transfer applicants will be placetl In the lottery. A name will b¢drawn for each vacancy that exists,antl each draw applicant will be offeretl admissions.The remaining mes will be drawn and placetl on a waiting Ilsf for each gratle level in the order they are drawn. e.If the school utilizes a lottery when oversubscribed,are any categories of applicants exemptetl from the lottery? (:Yes ("No C'No[applicable(because lotteries are not utilized) If"Yes"was indicated in C above,state the categories of appltca nts that are exempted. Please see the attachment Board policy(Na.1,02-page 2)for details regarding each group: 1.the children of the Town of Westlake employees(with percentage limitations) 2_the children of the Founders of Westlake Academy(with percentage limitations) 3.siblings of admitted or returning students D. If the school utilizes a lottery when oversubscribed, specify the approximate date on which a lottery will be conducted. Approximate Oate of Lottery(Month/Day) 02/l8 E. If the school does not utilize a lottery when oversubscribed, but rather fills the available positions in the order in which applications were received before the expiration of the application deadline (i.e., a "first-come, first-served" admission process), describe the manner in which the school notifies the community of the opportunity to apply for admission. TEC §Z2.117 requires a charter school [hot uses q frrst-came, first-served odmisslon process when oversubscr/bed [o pub/ish q noKce in q newspaper of genergf circulation not later than the seventh day before the application deadline. NA F. If the school has a separate process for re-enrollment,state the process and the timeline to be used. Intent to re-enroll is sent out xo all families in late February/early March. Registration takes place in August. For re-enrolimerrt, families complete part of the enrollment process online and then have several days To attend registration where xhey tan meet with a Westlake staff member to complete the registration process. G.State the procedures for processing applicatons received once the application deadline has passed. Applications for participation in the lottery are accepted from Dec mbar 1 through January 31 each year. If an application is completed after the deadline of January 3T,the student will be placed at the bottom of the wait tlst that is established for the child's grade in February In the date order the application is received. M. Describe[ha Information that an applicant must provide in ortler to be considered for admission.Applicants moy not be required to provide copes of transcripts or other academic records until after [hey a ojjered odmisslon and o enro//Jng. Furthermore, a student moy nq[ be precluded from enro/ling due [o the charter schoo/'s failure to recefve infarmg[ipn r¢quired far enro//ment from the student's parent or guardian or prey/ous schoo/.See TEC§25.002. Applicants must provide:current grade level,name,date of birth,school district to which student Is zoned,guardian information,physical address,email address,and proof of residency. An applicant seeking admission based on a grandparent's after school care musT submit additlonal do<umenTation regarding the amount of after school care. 1. The charter holder certifies that the non-tliscrimination statement required by TEC, §12.111 (nJ(SJ is printed in the school's atlmissign policy. TEC, §32.211 (g)(5J requires that a charter schoo/'s gdmiss/on po//cy/nc/ud¢a stotement that the schoo/wi/) not discriminate in admissions bgs¢d on gender, nations/ origin eihn/dty, re//g/on dlsgb//lty, gcademic, ortisriq or oth/eric obi/ity, or the dJstrict the chi/d wou/d otherwise attend. (i Ves C'No J. Ooes the admission policy either require or permit the school to exclude from atlmission all students with documented histories of a criminal offense, a juvenile court adjudication, pr discipline problems antler TEC Chapter 37, Subchapter A as authorized by TEC§12.111(oJ(sJ(BJ? ('�Ves(The school excludes such students or reserves the right to exclude such studenss from admissions.) C No(The school does not deny admission to such students based on their tlocumentetl hlstoNes of misconduct) Submit • A current copy of the admission policy that Incorporates the information provided in the above answers fo questions A through H antl any other relevant Information (Attachment 3); • A blank copy of the current admission application, i. ., the information requestetl when the student first seeks admission (Attachment 4);and • A blank copy of the current enrollment form(s), i.e., the information required once an applicant has been offered admission and is registering for enrollment(Attachment B) Attachment 3 TOWN OF WESTLAKE WESTLAKE ACADEMY BOARD OF TRUSTEES POLICY Policy No. '1.02: Date Board Adopted: May 4, 2009 Date Board Amended: June 1, 2015 Eff¢ctive Date: June 1, 2015; contingent upon TEA approval Policy Category: Admissions Policy Name: Westlake Academy Admissions Policy Policy Goal: Communicationlfransparency of student and parent requirements for admission into Westlake Academy; Engagement of stakeholders and fiscal stewardship Policy Dascri ption: Applications from new students are accepted from December 1" through January 3181. Currently enrolled students receive a Notice of /ntent to Return form the first week of January. This form asks students to state whether they intend to return to Westlake Academy the following school year and to identify any siblings who wish to attend Westlake Academy the following year. This form must be returned by January 31". Currently-enrolled students, admitted after Aug ust 1,2015, expressing a desire to return and who continue to reside within an approved geographical boundary are automatically enrolled for the following school year upon timely receipt of the Notice of /ntent to Return form, subject to the following limitations: (1) a currently-enrolled student who originally obtained admission to the Academy based on the student's residency in the primary geographic boundary; and (2) a currently-enrolled student who obtains admission as the child of a full-time Town of Westlake employee retains the right to re- enrollment only if the student's parent continues to be employed by the Town of Westlake on a full-time basis. Vacancies in each class are then determined. If the number of eligible applicants does not exceed the number of vacancies, then all eligible applicants who timely applied will be offered admission. If there are more eligible applicants than available spaces in a class, then admission shall first be offered to eligible applicants residing within the geographic boundaries of the Town of Westlake (primary geographic boundary). After consideration of all eligible applicants from the primary geographic boundary, Westlake Academy may admit eligible transfer applicants residing within the secondary geographic boundary. If the number of eligible transfer applications exceeds the number of vacancies, the admission of transfer applicants from the secondary boundary shall be tleterm fined by lottery, except that the following applicants are exempt from the lottery and may be given priority in admission, subject to the limitations identified. Exempt transfer applicants will ba admitted in the following order: ('1) the children of Town of Westlake employees, so long as the total number of students admitted under this exemption as the children of employees assigned to municipal duties constitutes only a small percentage of the total school enrollment and the number of students admitted as the children of employees assigned to Westlake Academy constitutes only a small percentage of the total school enrollment; and (2) the chiltl ren of Founders of Westlake Academy, so long as the total number of students admitted under this exception constitutes only a small percentage of the total school enrollment; and (3) siblings of admitted or returning students. All eligible transfer applicants will be placed in the lottery. A name will be drawn for each vacancy that exists, and each applicant whose Hama is drawn will be offered admission. The remaining names will be drawn and placed on awaiting list for each grade level in the order they are drawn. If a vacancy arises, the individual on the waiting list with the lowest number assignment will be offered admission. Applicants are not required to provide copies of transcripts or other academic records prior to enrollment. In addition, a student will not be precluded from enrolling due to Westlake Academy Charter School's failure to receive the information required for enrollment from the student's parent and/or previous school. Westlake Academy Charter School does not discriminate in admissions based on gender, national origin, ethnicity, religion, disability, academic, artistic, or athletic ability or the district the child would otherwise attend. rvr�ams screen snor wrs-iz-roma.os.iz wM.png Attachment4 '�,��st�iai:� �,cat3er��t ��ucient /�p�iica�tion for �tJ16- .2017 Required l��rtic��ion for [_csttery C:lrr�:�-:2. Gr-vhu �cve_I of Student +. This ice.the grade that your child is currently attending. t.�rndcr. Lsvei as of Sept 1, 2111E Tnis mull be the grade tha t your child is going into for The ZOt 6-ZOl7 school year. � � 1 t+rdenc rir5t Name ._ .. .. I stud��t Last Name Cate .�;- fit•-E.ff Mq/ oey/Year `;ch�:c• c�_uicc xha* student is zoned to acEend according to primary address -- — — —�� i''rimary Guardian FIr-st Name x Primary contact for 1_ottery With Whom Student Lives Primary G�1ardEan �s;-t Name.. Primary Contact for Lottary With Whorn Student Fives our::u.o..a.a��a�e.«,,.,rn.nar,.roi®�..no.n siac arsa�a.w3o?profemo,=r ur 12/102015 Screen SM1at 20I5-12-10 a[8.05.28 AM.pag Relationship * Attachment a Primary Guardian I, G) Street Address of Primary Guardian example:2600 JT Ottinger Road _� City, State of Primary Guardian * exam le:Westlake TX f Zip Code If Primary Guardian * �Ple:76262 —— —� Uay Phone of Primary Guardian exa�le: 000-000-0000 ---II _- .—___._— _._ _- —J Ceti Phone of Primary Guardian example_000-000-0000 __ Email Address of Primary Guardian * Verify Email Address of Pr[mary Guardian i Last Name Additional Guardian Contact Name First Name Additional Guardian Cc nta_ct Name h[[pz://mail.google.wm/mvIAVO/pinbox/ISISe38I543tl403e?p jecwr=1 1/1 12g02015 Scrxn Shot 2015-12-IO at H.0432 AM.png Attachment 4 Westlake Academy Student Application for 2C71C -� 2017 Applications for participation in the lottery are accepted from December 7 st through January 3l st each year. If you co mpiete an application after the tleatlline of January 37 st, you will be placed at the bottom of the wait tilt that is asta blished for your child's grade in February. We accept applFcatio ns for students who are entering Kindergarten through Grade 7 7 only. Your chiltl must be S years of age by September 1, 2076 to enroll ill Kindergarten. The Lottery will be held on February 78, 2076 from 5:00 pm to 6:00 pm in the Multi Purpose Hall. The tlrawing is open to the public, however attendance during the lottery tlrawing is not required. Please only submit one application per student.Students must reside within one of the districts listed below. This form does not need to be filled out for children who currently have a sibling enrolled at Westlake Academy_ Si biings of existing students are placed on the Sibling Waitlist. "Required Application Date Mon/Day/Year Do you currently have a stbling enrolled at We.�-tlake Academ}I? Yes C• No Continue. 25%completed hnpa://mail.googlc.com/mvl/u/O/#inbos/IS I8c383543tl403c1p�ojectar=l 1/1 r vv wza r s s��n snot za r s-r zao+r e.osno wrn.p�a Atta ch men[4 Ad diYionai Guardian Contact Name _ . _ _ _ _. . �'.:.si L :r:SFdp Additional/Other Guardian U�y i>hun- Atltlitional/Other Guardian (example: 000-000-0000) i.-•;� anon•. Additionali Other G�ardiau (exam Ple:000-000-0000) Additional! Uiher Guardian �i�rIE�; �m•ait Address Additional/Other Guardian Ftaw many s_udents. ftarn 'this family, Wiil b:: applying fur the. Wes'uake Academy Lottert/7 + I � 1 a Bao1c Continua+ �- �� 50%completed Hors:nm:ais��s�=.��.✓�„=umiwai�ne.nss�arsusaaoa�+p.oi��m.=v vi Attachment 4 ii`. S� — Y WestlaKe Academy Student Application for 20Y 5-Y 6 School Year nppllG o, .n.y iv... � orada Level Data or .n.v rva.. as oe se t.t zots R;nh i Midtlla La¢t Nam Nem Name cnaa tlis[nct s and� SCM1ooI stutlent is auam�naa io anentl naa to angina ng to aware¢ �owing to aaa.ess Ciil �t d�s;Lti.e1S]a=..¢•i - 4C5[Yiitt31xL5�. Primary Guartllan (s) RalationsM1ip w,m wnnm swaent uses Streal Atltlress cuy, sea mp Oay PM1ane Call Phone Email atltlress Fax . .. s :>_. w t_ :Yv .. Other Guartllan RelationsM1lp Street AtldreSs City.Sta[ Zip Oay Pnone Cell Phanc Bnal atltlress Fax Da[6 Applleation Rersioed meY rvm• Au`e etl b Gratla varifiatl Vea Notes Entarad Yn Computer vea Sblings amolkitl at Waaliaka Acatlamy CEO of Westlake Acatlemy X NOTES: WaatlaKa Flasltlarrta will ba nOtlflatl wFM approval prm¢sa la ttmplate In ortler to racNva raglstraticn matarlal¢. YWI anlltl mast ba 5 by September lvt to anrcll In Klntlargartan at Westlake Academy. Attachment 5 Enrollment Checklist Complete Steps 1 and 2 prior to Registrarion Week This will help speed up tine process at registration. Step 1: ➢ Update all student and parent contact information in the Parent Portal; please follow directions in the email to set up access. Step 2: Print out Forms for each individual student and complete. o Enrollment Form o FERPA Notice o Residency Affidavit (Westlake Residents Only) o Medical Form For the School Nurse o TEA Ethnicity Form o Home Language Survey o Parking Sticker Form (For high school drivers) Print out a set of family forms and complete. o IPad agreement and insurance waiver o Bach to School Supply Fee Form (optional) o Volunteer Forms (it is recommended to have one completed at the start of the school year for each parent) o HOC (House of Common) donation and volunteer form ➢ Gather all supporting documents for registration verificarion. o A copy of your ID with your current address • If you recently moved,your ID must be updated before it can be accepted as proof of residence. NO INCOMPLETE paperwork will be accepted.If all documentation is not submitted prior to the First day of school,students wilt not be permitted to start. o A copy of a current utility bill with your current address. • The combination of ID and utility bill is used as proof of residency that your family lives in an approved primary or extended boundary to attend Westlake Academy.All families are required to provide this at registration. o Students Documents that are required • Current immunization record. Attachment 5 Birth Certificate (IFa child is under the age of 11 an official birth certificate must be presented at the time of enrollment,a copy will be made for your student's permanent records) Copy of Their social security card o For students Grades 8-12,please provide a copy of their transcript and last report card. ➢ Do NOT forget the checkbook,all Westlake Academy Fees (athletic fees,after school activities, school supplies,i-Pad insurance,etc) may be paid with one check this year. Step 3: ➢ Plan to attend registration days August 4w, Sw, and 6t^ ➢ Be sure to bring all paperwork and payment, no incomplete packets will be excepted. Special Enrollment Items ➢ If enrollment is due to a Grandparents after school care,we will need a new Grandparent Af£davit submitted,along with a copy of the Grandparent's [D and utilfty bill. ➢ If you currently lease a property in Westlake,a current lease agreement must be received showing the property is leased through the end of the school year. ➢ Families under a building permit exemption will need to provide a copy of their current residency utility bill and matching photo ID as proof they live in an approved extended boundary. ➢ For any other special circumstances please contact the Registrar directly. Attachment 5 Enrollment Form Student Name: Grade: For 2015-2016 school year Last, First School District/School Information School District student is zoned for based on home address and grade for 2015-2016 school year. ISD NAME: What campus in the ISD would your student attend for the 2015-2D16 school year? CAMPUS NAME: What school did your student attend last year for the 2014-2015 school year? CAMPUS NAME: New Kindergarten Students leave blank,unless they attend Kindergarten in the previous year. Email/Electronic Correspondence Consent Q Yes, 1 would like to communicate via the email address 1 provided in Parent Portal. Q No, I would not like to communicate via the email address 1 provided in the Parent Portal. Agreement of Support: Q Yes, I agree as a parent/guardian of a child attending Westlake Academy to abide by rules, policies,and uniform standards as outlined in the Parent Student Handbook. Q No, I do not agree as a parent/guardian of a child attending Westlake Academy to abide by rules,policies,and uniform standards as outlined in the Parent Student Handbook. Technology Agreement of Support: Q Yes, I have read and agree as a parent/guardian ofa child attending Westlake Academy to the technology agreement. Q No, I do not agree as a parent/guardian of a child attending Westlake Academy to the technology agreement. Attachments IPad Insuranc¢: Q Yes, 1 have opted into the IPad insurance and have read the conditions and terms.1 have submitted payment for insurance,and understand that insurance is not valid until the payment is received. Q No,1 do not want IPad insurance and except full financial responsibility far any costs associated with damage or loss of the IPad. Volunteer Program Confidentiality S[atem¢nt: Q Yes,I agree to abide by all Westlake Academy Confidentiality rules as outlined in the agreement document Q No, I do not agree to abide by all Westlake Academy Confidentiality rules as outlined in the agreement document. I hav¢r¢ad and reviewed with my child all information contained on this enrollment form,and agree io abid¢by it. Parent Signature Date Special Services Questionnaire: My Child HAS RECENED the following services: Q Dyslexia Q Speech Q Resource Q Other Special Education Services Q Counseling Q HSL Q Bilingual Q Title 1 Q Chapter 1 Q 504 Q Pre-K/Early Childhood Special Services Q Other Parent Signatur¢ Date Attachment 5 Welcome to Westlake Academy TxConnect application[ Here you will have access to current school-related information about your students, including registration paperwork and during the school year attendance_ Step 1: At this point you have set up your username and password_ You may have entered the .. �� for each of your students_ If you see each student listed to the left than you are ready to select the Button_ Step 2: Select the Edit Student Settings Button, here you will select to have the Registration Key sent to your email to complete the initial set up- Please pay attention to the email that the Key is being sent to.� Step 3: Once you have entered the Registration Key, on the main page you will see a new button under your student's names. , this is were you will access your Fall Registration Forms. Please do so for each student. 'k"`If you do not see their names listed please go to MY ACCOUNT to enter Portal IUs, select the button to add each student. 'K Attention Hotmail users: At this time some families are not receiving the Registration Key email, even though is states it has been sent_ We are currently working on the issue. Attachment 5 STUDENT NAME GRADE ACADEMIC YHAR 2015-2016 '"` ` � ) WESTLAKE ACADEMY FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT (FERPA) SIGNATURE PAGE STUDENT DIRECTORY INFORMATION-LEGISLATIVE UPDATE (SEC. 26.013) Westlake Academy provides to the parent of each student at the beginning of each school year: (1) A written explanation of the provisions of the Family Educal3onal Rights and Privacy Act of 1974 (20 U.S.S.Sec.1232g),regarding the release of directory information about the student and (2) Written notice of the right of the parent to object to the release of directory information about the student under the Family Educational Rights and Privacy Act of 1974(20 U.S.C.Sec. 1232g). NOTICH According to state and federal law,certain information about district students is considered^directory information"and will be released[o anyone who follows the procedures for requesting the information unless the parent or guardian objects to the release of the directory information.IFyou do not want Wesllahe Academy to disclose directory Information from your child's education records without your prior written consent,you must notify the district in writing within iOdays.Westlake Academy encourages parents to use this form For the written consent notification. Westlake Academy has designated the Following information as^directory information": • Students name,address,telephone listing,email address,phomgraph,date and place of birth. • Students major field of study,degrees,honors,awards,dates of attendance,grade level,most recent school previously attended,participation in officially recognized activities and sports,weight and height[if a member of an athletic team],and enrollment status. A parent is allowed to record their objections to the release of all information or one or more specific categories of the directory information. © Westlake Academy has my permission to use directory information for school-related communications and publicity ONLY.I understand this may include the use of directory information For.yearbook,newsletters,Westlake Academy website,videos,HOC,WAAC,Town of Westlake,Westlake Academy Foundation,etc.) Westlake Academy should NOT release my child's student directory information fnr ANY reason. Example: Ifyou check this box,your student's name will NOT appear in school publications or local newspapers if he/she wins an award.NOTE:lF you check this box,your student will not be included in the school yearbook. Parent Signature: Parent Name (Please Print): Attachment 5 Texas Education Ag®ncy Texas Public ScFtool Student/Staff Ethnicity and Race Data Questionnaire The United States Department of Education (USOE) requires ail state and local¢ducaUon institutions to collect data on ¢th nicity and roc¢for students and staff. This informati<tn is used for state and f¢daral accountability r¢porting as well as for r¢porting to the Office of Civil Rights(OCR)and the Equal Employment Opportunity Commission (EEOC). School district staff antl parents or guardians of students¢nrolling in school are r¢quested to provide this Information. If you decline to provide this Information, pl¢ase be aware that the USDE requires school districts to use observ¢r identification as a last resort For collecting the data for federal reporting. Please answer both parts of the Following questions on the student's or staff member's ethnicity and race. United States Federal Rag/st¢�('/1 FR 44866) Part�. Ethnicity: Is the person Hispanic/Latino? (Choos¢only one) � Hispanic/Latino-A person of Cuban, Mexican, Puerto Rican, South or Central American,or other Spanish culture or origin, regardless of roc¢. � Not Hispanic/Latino Part 2. Race: What is the person's race? (Choose one o�moreJ 0 American Indian or AlasKa Native-A person having origins in any of ttie odginal peoples of North and South America (including Central America), and who maintains a tribal afFliafion or community attachment � Asian -A parson having oHgins in any of the original peoples of the Far 1=aet, Southeast Asie,or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea,Malaysia,Pakistan, the Philippine Islands, Thailand,and Vietnam. � Black or African American -A person having origins in any of the black racial groups of Africa. � Native Hawaiian or Other Pacific Islander-A person having origins in any of the original peoples of Hawaii,Guam, Samoa, or other Pacific Islands. White-A parson having origins in any of the original peoples of Europe, the Middle Eas[, or North Africa. �Studetrt/Staff Nama (please print) (ParenUGuardian)/(Staff)Signature _. Student/Staff Identification Number Data Tezua FAuution Agcney-MereF 2010 Attach meni 5 WESTLAKE ACADEMY HOME LANGUAGE SURVEY TO BE COMPLETED BY PARENT OR GUARDIAN (OR STUDENT IF GRADES 9-12]: The state of Texas requires that the Following information for each student that enrolls for the first time in Texas public schools.This information shall be kept in each student's permanent record Folder. TEXAS EDUCATION AGENCY, BILINGUAL EDUCATION REQUIREMENT PLEASE PRINT OR TYPE STUDENT SOCIAL SECURITY# FULL LEGAL NAME GRADE LEVEL AS OF SEPT 1, 2015 WHAT LANGUAGE IS SPOKEN [N THE HOME MOST OF THE TIME? WHAT LANGUAGE DOES THE STUDENT SPEAK MOST OF THE TIME? BY SIGNING VOU AFFIRM THAT THE INFORMATION PROVIDED ON THIS FORM IS TRUE AND CORRECT. SIGNATURE OF LEGAL GUARDIAN DATE Attachment 5 2015-2016 Grade WESTLAKE ACADEMY EMERGENCY iNFORMAT(ON FORTH SCHOOL HEALTH CL1N(C Students Legal Last Name Students Legal Firs[Name Students Legal Middle Name M/F BirNdate EMERGENCY CONTACTS:THE PARENT WILL BH CALLED F[RST.If a parent cannot be reached,emergency contacts will be called. Please note that contacts should be local,as they may need to pick up your child in case of illness. Parent Name(s): Home Phone�) Mom's Daytme Phone:�) Dad's Daytime Phone: �] Mom's Cell:( J Dad's Cell Phone:O Emergency Contact Name: Relattonship to Student: Home Phone:(_J Ceil Phone: [ ] Doctor's Name: Doctor's Phone:L ) M DICAL RELEA In case of accident pr sertcus Illness,I request the school to contact me.If the school is unable to reach me,I herby authorize the persons]list¢d as ergency Contacts and Doctor to be nodf[ed at the school's discretton and do auiharize the nam¢d doctor/¢m¢rgency dotter to r¢nder such treatment as may be deemed n ary In an emergency,for the health a(said child.If it is Impossible got N¢school to contact the physician.Ne school may make whatev¢r arrang¢m¢nts necessary wt[h th¢medical professional(sJ available[¢give all necessary treatment m my child.I Further assume[he r¢sponslblLty For paym¢n[of any pr¢F¢sstonal emergency services 2quired. R N 1 P RMA I Aller fe Di 1If[ie df anon List all allergies: Reactlons: Has your child used an EPI-PEN for any of these rxns? IFyes,how long since tt was necessary? PLEASE BRING AT LEAST ONE EPI-PEN INTO NURSH'S OFPICH IP YOUR CH[LD REQUIRES ONH POR SEVERS REACTION List any health conditions or concerns(include seizures,asthma,diabetes,frequent headaches,etc.): Recommended treatment at school for above health conditions: If student will need an inhaler for rescue or maintenance of asthma,please sand it to Nurses OfRce List current medications(include non-prescription and herbal]: KSN P X LLNE Has your child had the chicken pox illness and does not need the Varicella Vaccine? On or about what dater Has your child NOT had the chickenpox illness but HAS BEEN vaccinated with the Varlcella Vaccine? The staff of Wesdake Academy has my permission to atlmints[er the following medicatlons as needed Far the temporary r¢II¢Fgf appropriate symptoms for[hose students ag¢s flue and older.please Hate Nat NO MEDICATION WILL BH GIVEN WITHOOT WRITTEN PERMISSION.IPyou want your child[o receive medi¢atlons without a phon¢call each tlmq this farm MOST be signed and returned. PI odic i n CIRCLE HERE for Il a ed below YES NO Acetamfnophen(Tylenol) VES NO Antibiotic Topt<al Ointment �Neasporin) YES NO Ibuprofen (Advil or Motrin) VES NO Topical Oral Anes[h¢tic YHS NO Naproxin Sodium(Aleve) VES NO Pepta Bismol YES NO Decongestant (Sudafed PE) YES NO Tums VES NO Diphenhydramfne(Benadryl) YES NO Cougtt Drops VES NO Hydrocortisone anti-itch cream YES NO Loratadin¢ (Clarion) Hy my signature below,I consent tp and give authorization for all areas detailed above on behalF ofmy chRd and[hat all information provided above is correct Parent/Guardian Signature: Date: • • - • • � The charter holder certifies it has policies antl procedures in place that ensure implementation of all fetleral laws and regulations, Texas laws, State Board of Education (SBOE) and commissioner of education rules related to students with tlisa bilittes antl further certifies any future amendments to the laws, regulations, and rules will be incorporated and implementetl. J Signature of Charter Holder Board Ghalr �Oaie (Mustsign in b/ue lnkl Laura Wheat Printed Name of Charter Holder Board Chair • • � � � • If the charter school is nn[ <urren[ly approved Lo serve students of resid¢ntial fadlities, do no[ provide a signature and indicate N/A on the signature line. If operating a charter school campus on the site of a residential facility(RF) or serving students residing in or receiving services from an RF,the charter holder chair certifies by signing the assurance that: Compliance with Spec/p/EducgNon Requirements:The charter holder assures that it will c mply with all of the requirements far the provision of educational services to students with disabilities as mandated by the Individuals with Disabilities Education Act, as amended, xhe Texas Education Code, and federal and state special education regulations. The charter holder acknowledges that state and federal special education requirements require, among other things, it provide a free and appropriate public education (FAPE) in the least restrictive environment (LRE) to students with disabilities residing in RFs. The charter holder further a ures that it will provide, or seek the provision of, a FAPE to students with disabilities, which may require It to contract with outsitle service providers or another local educational agency to provide necessary services and supports to students with disabilities. G¢ogrophlc Sogndgr/es: The charter holder assures that It will accept students who reside in the school districts) that are within each campus's geographic boundaries regardless of the presence or absence of a disability or admission to or participation in an RF program. Admissions C�iterip:The charier holder assures that its admissions criteria will not be based on the presence or the absence of a disability; or on gender; national origin; eth nlcity; religion; academic; artistic or athletic ability; or the home district the child would otherwise attend. Schoof Cho/ce:The charter holder assures that parents/legal guardians(or atlult students)will be advised that they may choose to enroll their child in either the charter school or the local public school district and that the elected choice will be documented in writing and filed for purposes of review or audit by the Texas Education Agency(TEA),an external auditor,or another entity. Res/dent/q/ Fgcl/(Hes Mon/taring (RFM) System: The charter holder assures that it und¢rsta rids that, pursuant to 19 (TAC) 597.1072, there is a specific system for monitoring school disiritts antl charter schools serving students with disabilities who side n RFs. The charter holder further a s that it understands iT will be required to report data related to students with disabilities residing in RFs In TEA's data collection system known as RF Tracker and it may be subject to RFM Intervention activities and on-site visits based upon a review of the data reported on a random selection or other means of selection. Training: The charter holder assures the[ all personnel involved with serving students with disabilities residing In a RF and personnel Involved with reporting data in RF Track¢r will receive training on the RFM system. Please contact your regional Educational Service Center for information regarding the required RFM system training. • • � � • � � • � • The charter bolder a s this document has been shared with, and understood by, the RF board and that the RF board has ackn wledged its nderstanding of all federal laws and regulations, Texas laws, State Board of Education (SBOE) nd of education rules related to charter schools serving students at residenxi al faci4fies and further certifies that any tutu re la mend menu t-o t/he laws, regulations, and rules will be incorporated an^d implemented. Signatu re Of Charter Holder Board Chair (Mustsign in b/ue/nkJ Laura Wheat Printed Name of Charter Holder Board Chair • C • - • � � • T xos Educo[/on Code, Ghoptcr 29, Subchoptcr B, TEC§22.104(6J(2)(G), and 19 TAC 4489.1201-69.1265 require charter schools to identify limited English proficient students based on state criteria antl to provide an appropriate bilingual education or English as a second language program conducted by teachers certified for such courses. A. The charter holder certifies it has poiicies and procedures in place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to limited English proficient students. C'Yes t—No Section 504 of the Rehabilitation Act of 1973,29 U.S.C. g794, prohibits discrimination on the basis of disability in any program receiving fetleral fine nclai assistance. A recipient that operates a public education program or activity shall provide a free, appropriate public education to qualtfled individuals. B. The charter holder certifies IS has policies and procedures In place to ensure it complies with the legal and regulatory requirements concerning identifying and providing appropriate educational services to students protected by Section 504. C."Yes (-'No Texas Education Code 438.003, TEC§22.304(6J(2)(KJ, 19 TAC§J4.28 and Section 504 of the Rehabilitation AR of 1973,29 U.S.C. §794, require charter schools to identify students with dyslexia or related disorders and To provide appropriate educational services. C. The charter holder certifies it has policies and procedures in place to ensure it complies with the legal and regulatory requirements concerning Identifying and providing appropriate ed ucallonal services to students with dyslexia or related disorders. t=Yes (- No I further certify the[any future amendmenss to the laws,regulations,and/r]u l�es will be incorporated and implemented. Signature of Charter Holder Board Chair (� �re (Musts(gn in b/uc inkl Laura Wheat Printed Name of Charter Holder Board Chair The charter holder certifies it Is in compliance with TEC 422.120, and confirms that nc individual is serving in any capacity if he she has been c victed of a isdemeanor i olving moral turpitude; a felony; an offense listed in TEC§37.007(oJ; offense listed In Artic/e 62.003[5J Code of C�/m/no/Procedures; unless the individual is eligible to be employed In a position in a school tlistrict under TEC 412.120(o-1J. Additionally, the charter holder confirms all current fingerprinting and criminal record checks are available for all employees, including contrac[employees; volunteers who indicated in writing their Intention xo serve; board members; and officers of the charter holder who ar¢not on the board,in compliance with TEC 4412.1059,22.0832-22.0835. Signature of Charter Holder Board Chair � Date (Mustslgn!n b/ue/n/p Laura Wheal Printed Name of Ghater Holder Board Chair ��mT _ This section requires at least a majority of the governing body of the charter holder to certify it has had an opportunity to review the completed renewal application and has authorized, during an open meeting, submission of the application to the commissioner of education for consideration of renewal of the charter. CERTIFICATE OF ACKNOWLEDGEMENT The undersigned members of the governing body of the charter holder h¢reby acknowledg¢that they have had an opportunity to review the completed renewal application and have authorized its submission, during an open meeting,to the commissioner of education for consideration of the renewal of the charter: iypetl Nam¢ Signature Date^ (Type name next to corresponding signaiur¢) (Must sign in blu¢ink)) Laura Wheat � 0 Alesa Belvedere Michael Barrett Wayne StoRcnberg Carol Langdon � Rick Renhack C Thomas Brymer ^Members ore to sign the acknowledgement during on open meeting;therefore, the dote next to each signature must ref/ec[[he dole f the meeting. m � . - Michael Williams COTTi55iOn¢r Of EduCat(On Lizzett¢C.Gonzal¢z R¢ynolds Chief Deputy Commissioner Michael Berry Deputy Commissioner, Policy and Programs Sally Partridge Associate Commissioner,Accreditation and School Improvement Heather Mauz� Director,Division of Char[er School Administration Far further information contact the �Ivislon of Charter School Administration at: Texas Education Agency 1701 North Congress Avenue Austin,Texas 78701 (512)463-9575 (512)463-9732 fax Email-Cha rte r5chools@tea.texas.gov Or visit the w¢bsite: http://tea.texas.gov/Texas_Schools/Charter_Schools/Charter Schools/ Bia^� _ . �. � ) \ _ §!§ ~ -/� } » . ©.�c. )� ) / �)� ) / � i _` � � i ( /$ ` ^ �,l ���( ]/� ]!� q\� ]|�� : � ! ; ` ! , ( / � / �� � \! .{(� , . ! /\ /| )/j \ � § ] § � � . . �m . , . . : » - � I ! j . ]))\ƒ )§ ))|\ � )/ \) � | ; ] � \jam . I ��� >�(! \ ��\ �-_:�. �lR � ){!{)( j{ �/ \� �� � ) �/^� Attachment B WESTLAKE ACADEMY CHARTER SCHOOL (220810) Ratings Vear Accountability Ratings Charter FIRST Rating Accredi[a[ion S[atus 20'14-20'IS Mat Standard Pass Campo ¢ Met$tandartl 1 20'13-20'I4 Ma<Stantlartl Sup¢tior ACM1iavam®nt ACCREOITE� Campo e. Met Starntlartl 1 2012-2013 Mat Standartl Substantlartl ACM1iev¢m¢nt ACCREDITED Campus¢s Me[Stantlartl 1 20t t-20t2 No Ratings Issu¢d Sup¢rior Achiavam¢nt No S[atus¢S lssuetl c.�m ntlsns No Ratings Issuetl 1 20t 0-20'1t Exomplary Standard Acbi¢vemant ACCREDITED Campo .� Exemplary 1 2009-20'10 Exemplary Standartl Acbiavamant ACCREDITED Ca mpusas Exemplary 1 Fntlay,November 06.2O15