Parent and Community Positions

Board Candidate Questionnaire

Parent and Community Positions

Please complete the following questionnaire for consideration to be nominated as a member of the Board of Directors. Please also attach a copy of your current resume or a brief biography statement.

Name:

Current Employer:Position:

Address:

Home Phone: ( ) Business Phone: ( )

Cell: ( ) Email:

Background Information:

University Preparation School Mission

The mission of the University Preparation School at CSU Channel Islands is to provide a standards-based education in a culture where all students thrive academically, socially, physically, and emotionally and where professionals demonstrate the skills and strategies necessary to assure that goal.

The school:

• Optimizes student potential and performance via instructional delivery by teachers who employ school-wide collaboration and articulation to facilitate the implementation of the best and most promising research-based pedagogical practices;
• Offers an educational setting in which classrooms reflect the ethnic, linguistic, socio-economic, and special needs diversity of California classrooms;
• Models the best and most promising research-based pedagogical practices for student teachers, other credential candidates, and practitioners;
• Serves as a laboratory for theoretical and action research which will contribute to the body of knowledge regarding curriculum, instruction, assessment, child growth and development, parent/community participation and education, and site administration;

University Charter Middle School Mission

The mission of the University Charter Middle School at California State University Channel Islands (UCMS) is to build a comprehensive learning community for sixth through eighth grade students. The program focuses on developing critical thinkers who demonstrate mastery of the California academic content standards in an environment that supports the unique developmental stages of the adolescent child.

UCMS will maximize learning opportunities for its students who will reflect the ethnic, linguistic, socio-economic, and special needs diversity of Ventura County and California classrooms by using the best and most promising pedagogical and standards-based practices employed by highly qualified teachers and administrators. These practices will be modeled for student teachers, other credential candidates, and a variety of practitioners through regularly scheduled on-site training and action research in conjunction with CSU Channel Islands.

University Charter Schools Guiding Principles

The Students...

create a positive community environment by exhibiting ownership of their education through self-discipline and high expectations.

The Curriculum...

is standards-based, fosters critical thinking skills, and utilizes best educational practices. It includes instruction in the core subjects (Language Arts, Math, Science, Social Studies) as well as in Spanish, technology, and the arts.

The Professional Community...

is dedicated to participating in on-going professional development that includes leadership capacity building, school-wide collaboration and articulation, communication of “best practices”, and team building experiences.

The Cooperating Community…

flourishes as a result of collaboration with CSUCI faculty and students, and because of strong relationships with involved and informed parents, with area districts, and with businesses that support the educational program.

Please provide a brief answer to each of the following questions:

1. Please list any past or present involvement you have had with the School:

1. What knowledge do you have about our School, its history, programs, and services?

1. Please describe briefly what you understand our mission to be.

1. What do you see as the strengths of the University Charter Schools?

1. What do you see as the area(s) most needing improvement in the University Charter Schools?

1. As a Board member, how will you help achieve the School’s mission and vision?

1. What specific strengths or skills can you bring to this position? Do you have a particular interest or skill (i.e., public relations, budget, long-range planning, facilities, policy, etc.)?

1. Why are you interested in being a board member?

Conflict of Interest Questions
[Please attach any supplemental responses on separate sheet of paper]

1. Indicate whether you currently or have previously served on a board of a school district or another charter school Yes. No.

If yes please list the board(s) and date(s) of service.

1. Do you or an immediate family member have a close personal relationship with the School or any individual(s) associated with the School that would make it difficult for you to execute your duties as a board member in an independent manner? Yes. No.

If yes, please describe.

1. Do you or any immediate family members have any contractual agreements (for example as a vendor, employee, landlord, etc.) with the School?

Yes. No.
If yes, please describe.

1. Have or will you or any member of your immediate family receive funds, gifts, loans, services or any other consideration for any purpose from the School or any other company contracting or providing service to the School? Yes. No.

If yes, please describe.

1. Will you or any member of your immediate family be leasing or selling any real property to the School? Yes. No.

If yes, please explain the arrangement in detail.

1. Have or will you or any immediate family members be guaranteeing or granting any loans or services—at no charge or for charge—to the School or any other company contracting or providing service to the School? Yes. No.

If yes, please describe.

1. Are or will you or any immediate family members be employed at the School (either directly or as a consultant/independent contractor be providing services to the School)? Yes. No.

If yes, please describe.

1. Do you or an immediate family member know any individual(s) or entities that do or plan in the next year to engage in business or any exchange of services with the School? Yes. No.

If yes, please describe.

1. Other than your current board position, do you currently serve as an elected or appointed public official? Yes. No.

If yes, please describe.

1. Do you foresee any potential ethical or legal conflicts of interest if you serve on the School’s board? Yes. No.

If yes, please explain.

1. To the best of your knowledge, are there situations not described in this questionnaire which may give the appearance of a conflict of interest between you or a member of your immediate family, or would make it difficult for you to execute the duties of your office in an independent manner? Yes. No.

If yes, please describe.

Certification

I hereby certify that the information contained in this Questionnaire is true and complete to the best of my knowledge and agree to notify the Board Chair of any change that may create a conflict of interest.

Signature: ______Date: ______

For additional information about our program, please visit the school’s website at or contact Charmon Evans at or 805-482-4608