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Charter Potential Profile

Required

Please note that all forms fields are required. Indicate not applicable or pending as appropriate.
Must contain a date in MM/DD/YYYY format
New or established?required
Petition approved or pending?required
Managementrequired
Program Type:required
Contact Person (Authorizer):required
First Name
Last Name
(for Authorizer)
Contact Person (Geographical SELPA):required
First Name
Last Name

Charter Site Location and Administrative Contact Information

Charter LEA CEO:required
First Name
Last Name
Director of Special Education Services:required
First Name
Last Name
Business/Fiscal Director Name:required
First Name
Last Name
CALPADS/SIS Name:required
First Name
Last Name
Administrator Name:required(for CMO)
First Name
Last Name
(for CMO)
Must contain a date in MM/DD/YYYY format
Has the charter submitted application(s) for membership to any other SELPA(s)?required
If YES, please provide the following information for each application.
Must contain a date in MM/DD/YYYY format
Status of application:required
Must contain a date in MM/DD/YYYY format
Status of application:required
Name of Individual Submitting Profile:required
First Name
Last Name
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