FY2008-2009 CHARTER SCHOOL CAPITAL CONSTRUCTION FUNDING ELIGIBILITY QUESTIONNAIRE School Information

FY2016-2017 CHARTER SCHOOL CAPITAL CONSTRUCTION FUNDING
FY2008-2009
ELIGIBILITY QUESTIONNAIRE
Charter School:
County:
District / Institute Charter:
School Code:
School Information
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Name:
School Address:
Phone Number:
Fax Number:
Email Address:
Contact Information
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
IMPORTANT: The email address provided will be used to contact the school for the verification of the pupil count and
funding amounts. You will not receive funding until we receive email verification back from you acknowledging the
October 1 pupil count and FY2008-2009
FY2016-2017 payment amount. Please ensure this is a working, monitored email address.
FY2016-2017
SECTION I: Certification of Charter Schools Eligible for Capital Construction Funding FY2008-2009
1. Is your charter school located in a district owned facility?
Yes
No
2. Is your charter school located in a facility that is listed on the state inventory of
real property and improvements and other asset maintained by the department of
Yes
No
personnel pursuant to section 24-30-1303.5, C.R.S.?
Yes
No
2.a. If you answered yes to question 2, are you making lease payments?
3. In order to qualify for funding, you must have capital construction needs
Yes
No
in FY2008-2009.
FY2016-2017?
FY2016-2017. Do you have capital construction needs in FY2008-2009?
SECTION II – Projection of Pupils in Eligible Charter Schools for FY2009-2010
FY2017-2018
1. What is your projected pupil count (FTE) for all pupils NOT in on-line programs
Pupil Count _______
for FY
2009-2010?
FY2017-2018?
FY2017-2018?
2. What is your projected online pupil count (FTE) for FY2009-2010?
Online Pupil Count _______
SECTION III:
lll: FY2009-2010
FY2017-2018 New
SECTION
NewCharter
CharterSchools
Schools
FY2017-2018?
1. Do you expect to start a new charter school in FY2009-2010?
2. Will the new charter school be in a district owned facility?
3. Will the charter school that will operate in FY2009-2010
FY2017-2018 be located in a facility
that is listed on the state inventory of real property and improvements and other
asset maintained by the department of personnel pursuant to section 24-301303.5, C.R.S.?
Yes
Yes
No
No
Yes
No
SECTION IV – Signatures
____________________________________
____________________________________
District or Charter Institute Representative – Printed Name
District or Charter Institute Representative Title
____________________________________
____________________________________
Signature of District or Charter Institute Representative
Date
____________________________________
____________________________________
Charter School Representative – Printed Name
Charter School Representative Title
____________________________________
____________________________________
Signature of Charter School Representative
Date
2016
DUE DATE: December
January 9,2,
2009
RETURN TO: Colorado Department of Education, Division of Capital Construction Assistance
1580East
Logan
Street,
Suite 310,
Denver,
80203
201
Colfax
Avenue,
Denver,
COCO
80203
Attn: Scott
AnnaNewell
Fitzer
For questions or concerns, please contact Scott
AnnaNewell
Fitzer
303-866-6184 Fax: 303-866-6888
Email: [email protected]
Direct: 303-866-6717
[email protected]
CDE, CCA
Form CSCC-02
Revised 11/8/08