WISCONSIN PARENTAL CHOICE PROGRAM
NOTICE OF SCHOOL’S INTENT TO PARTICIPATE
2013-14 SCHOOL YEAR
PI-WPCP-102 (New 07-13) / INSTRUCTIONS: Submit completed and signed form, to arrive at DPI no later than JULY 26, 2013, to:
WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION
ATTN: TRICIA COLLINS
PARENTAL PRIVATE SCHOOL CHOICE PROGRAM
P.O. BOX 7841
MADISON, WI 53707-7841
Collection of this information is a requirement of s. 118.60, Wis. Stats.
TYPE OR PRINT / GENERAL INFORMATION
School Name / School Year
2013-14
Address for Each School Location Street, City, State, ZIP Attach additional sheet if necessary.
Mailing Address If different than above / Phone Area/No. / Fax Area/No.
Choice Administrator’s Name / Title / E-Mail Address
Choice Administrator Address, Other than School Street, City, State, Zip
Under s. 118.60(2)(a)6.b. Wis. Stats., administrators of private schools participating in the Wisconsin Parental Choice Program (WPCP) must have at least a bachelor’s degree from an accredited institution of higher education. Check “Yes” if the administrator meets this requirement and provide the name of the accredited institution of higher education and month and year the bachelor’s degree was received. Check “No” if the administrator does not meet this requirement. A private school that does not comply with this requirement is ineligible to participate in or receive funding under the WPCP. If any of the information provided in answer to this question is found to be incorrect or misrepresented, the private school will not be eligible to participate in or receive funding under the WPCP.
Yes No The administrator listed above has at least a bachelor’s degree from an accredited institution of higher education.
Name of Accredited Institution of Higher Education / City / State / Date Bachelor Degree Received Mo./Yr.
NOTICE OF INTENT
This notice of a school’s intent to participate in the Wisconsin Parental Choice Program (WPCP) in the 2013-14 school year is due at the Department of Public Instruction no later than July 26, 2013, along with the following:
(1) the school’s proposal stating how pupils will be accepted, on a random basis, from a new pool of applicants each year;
(2) the original letter from the State Superintendent regarding student rights in the WPCP, signed by the school administrator; and
(3) the auditor fee in the amount of $900 made in the form of a cashier’s check made payable to the Department of Public Instruction and the completed auditor fee form.
The school administrator listed above is to sign at the end of the application, attesting to the private school’s agreement to comply with all the requirements of Wisconsin Statute 118.60.
AGREEMENT / SIGNATURES
THE SCHOOL AGREES that compliance with all of the requirements in Wisconsin Statute 118.60 constitutes a condition of receipt of funds under the above-referenced program, and that this notice of intent to participate is binding upon the school, its successors, transferees, and assignees for the period during which the school is a participant in the program. The school assures that all contractors, subcontractors, subgrantees, and others with whom it arranges to provide services or benefits to its students in connection with this program are not in violation of the stated statutes, regulations, guidelines, and standards. In the event of failure to comply with WPCP requirements, the school understands that its participation in the program can be terminated.
I, the undersigned, am authorized to sign this form on behalf of the school as either sole owner or by appointment as administrator by the school’s operating organization, and I am not a disqualified person as defined under s. 118.60 (1)(ag) Wis. Stat. A disqualified person is defined as a person who for a period of seven years from the date of an order terminating or barring a school issued by the state superintendent had a controlling ownership interest in, or was an officer, director or trustee of a private school barred or terminated from the program, or was the administrator of a private school, a person identified as an administrative designee, or an individual responsible for the activity that resulted in an order being issued barring or terminating a private school from participation in the program. By signing this form, I acknowledge that if the private school is barred or terminated from the program, I may be prohibited from having an ownership interest in, serving as an officer, director, trustee, administrator, or administrator designee or person responsible for administrative, financial or pupil health and safety matters, for compensation or as a volunteer, at another private school participating in the choice program for seven years from the date of the state superintendent’s order barring or terminating the private school from the program.
Section 118.60 Wis. Stats., is subject to statutory and administrative rule change. I have read the notice and guarantee that the school will comply with all its provisions.
School Name
/ Choice Administrator’s Name
/ Phone Area/No.
Choice Administrator’s Signature
Ø / Date Signed Mo./Day/Yr.
OPEN APPLICATION PERIODS FOR THE 2013-14 SCHOOL YEAR
Check one or more boxes to indicate the open application period(s) your school will conduct for the 2013-14 school year.
Beginning Dates / End Dates
August 1 / August 9
September 1 / September 14
October 1 / October 20
November 1 / November 20
December 1 / January 7
2013-14 SCHOOL YEAR ESTIMATES
If the private school has more than one unique campus location, provide a separate estimate table for each location.
Grade Levels Served / A. Total Student Capacity
WPCP and non-WPCP students / B. Total WPCP Students
WPCP students only
4-Year-Old Kindergarten – 0.5 FTE
4-Year-Old Kindergarten – 0.6 FTE
5-Year-Old Kindergarten – 0.5 FTE
5-Year-Old Kindergarten – 1.0 FTE
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Total / 0 / 0
These numbers represent the school’s estimated enrollments for the 2013-14 school year. State law limits the number of students that may participate in the program; therefore, actual choice pupil enrollment is not guaranteed and may be lower than the numbers listed above.
2009-10 Wis. Stats. database current through 2011 Wis. Act 286. Includes all Legislative Acts and all Supreme Court Orders enacted before Oct. 1, 2012. Statutory changes effective on or prior to Oct. 1, 2012 are printed as currently in effect. Changes effective after Oct. 1, 2012 are designated by NOTES. See Are the Statutes on this Website Official? (10-3-12)