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Second Generation Open Enrollment Charter

Renewal Application

Fast-TrackAbbreviated Renewal

Schools Eligible for Fast-Track Renewal

Alief Montessori Burnham Wood

Encino Kipp Inc

Mainland Preparatory Academy NYOS

Rapoport Treetops School International

Varnett

April 18 2002

Texas Education Agency William B Travis Building

1701 North Congress Avenue Austin Texas 78701-1494

Dated Material---Open Immediately

Return on or before--500 pm Central Time Friday June 14 2002

Charter Schools Division Room 5-107

Application Instructions

The Renewal Application is due to TEACharter Schools Division by 5 00 pm June 14 2002 Applications will be date stamped as they are received and the date received will be documented Timely submission ofa complete renewal application may be used as part of the basis for renewal determination

The application form has been designed to be downloaded and responses can be entered directly onto the electronic application form on your computer The spaces provided for answering questions are expandable Use as much space as needed for responses

Attachments should be labeled as indicated in the application and submitted in prescribed order The forms for Attachment 3 Board Member Biographical Affidavit and Attachment 5 Electronic Application Certification are included with the application

Seven complete paper copies of the entire document must be submitted in prescribed order with only original signatures in blue ink One copy (less attachments) must also be submitted on a 35 inch floppy diskette (The agency uses a PC compatible text file)

Format ofApplication

Number of paper copies 7 Font 12 pt Times New Roman Paper 85xl 10 white one side only Binding NONE DO NOT BIND

May be rubber-banded or clipped

List ofAttachments

Attachment I Organizational Chart Attachment 2 Criminal History Records for Board Members Attachment 3 Board Member Biographical Affidavits Attachment 4 Special NeedsPrograms Information Request Attachment 5 Electronic Application Certification Attachment 6 Written Resolution Adopted by Goveruing Body of Charter Holder

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Definitions

Please review TEC sect121012 and 19 TAC Chapter 100 sectIOOlOll for definitions oftenns Listed below are some selected tenns and definitions

I Charter holder - the entity to which a charter is granted under TEC Chapter 12

2 Charter school- a Texas public school operated by a charter holdcr under an open-enrollment chartcr granted by the State Board of Education pursuant to TEC sect12101

3 Governing body ofa charter holder - the board of directors board of trustees or other governing body of a charter holder

4 Governing body ofan open-enrollment charter school- the board of directors or other governing body ofan openshyenrollment charter school The tenn includes the governing body ofa charter holder if that body acts as the governing body of the open-enrollment charter school

5 Management company - a person other than a charter holder who provides management services for an openshyenrollment charter school

6 Officer ofan open-enrollment charter school - the principal director or other chief operating officer of an openshyenrollment 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

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General Scope of Agency Review

As authorized in Texas Education Code sect 12115 the conunissioner may modifY place on probation revoke or deny renewal of the charter ofan open-enrollment charter school if the conunissioner determines that the charter holder

I) conunitted a material violation of the charter including failure to satisfY accountability provisions prescribed by the charter

2) failed to satisfY generally accepted accounting standards of fiscal management 3) failed to protect the health safety or welfare of the students enrolled at the school or 4) failed to comply with this subchapter or another applicable law or rule

The Commissioners Rules Concerning Open-Enrollment Charter Schools 19 TAC Chapter 100 provides more specific information about commissioner action and intervention and other issues concerning open-enrollment charter schools

Internal reviews for all renewal applications will be conducted by TEA staff in areas such as student performance business operations and fiscal management and compliance Components for determining adequate student performance generally include accountability ratings AEIS indicators and other relevant student performance information as reported by the charter school on this application and as supported by required evidence and documentation

Components for evaluating bUSiness andfiscal management generally consist of a review by the Financial Audits Division of annual financial audits and other relevant documents

Agency compliance requirements that may be generally considered include but are not limited to timely and accurate submission ofgrant expenditures and evaluations PEIMS reports accountabilityaccreditation information (including data requested prior to on-site visits and follow-up information such as corrective action plans for bilingual and special education programs and PASIDAS risk levels) assessment requests (including requests for and submission of testing materials) other special education information governance data student transfer data required by Civil Action 5281 and the renewal application

Complaints made against the charter school through the Agency complaints process may also be considered as well as any issues concerning the health safety and welfare of students

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Open-Enrollment Charter School Renewal Application Generation Two - Fast-TrackAbbreviated

Part 1 Charter Update

Charter Holder Name EI Paso Education Initiative Inc (ie nonprofit organization institution of higher learning or governmental entity)

Charter School Name Burnham Wood Charter School

Charter School CountyDistrict 07180 I

Campus Name(s) CountyDistrictCampus

Burnham Wood Charter School 07180101

Burnham Wood Charter High Scho 07180102

Section I Maximum Enroilment Grades Served and Geographic Boundaries In the spaces below please list the maximum enrollment the grades the charter school serves (indicating if there is an approved GED program) and the geographic boundaries

A Maximum Enrollment 324

B Grades Served As per charter Kindergarten through twelvth grade (The elementary campus servers kindergarten through fifth grade and the high school campus serves the ninth through twelveth grades)

Approved GED Program YESD NO I8l

C Geographic Boundaries (School Districts) EI Paso independent School District Ysleta independent School District Socorro Independent School District and Canutillo Independent School District

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Section II Governance Structure and Procedures Review TEC Sec 12121 and 19 TAC Chapter JOO Division 5 (Charter School Governance) which lists among other things powers and duties that must be exercised by the governing body of the charter holder and nepotism and conflict of interest prohibitions and exceptions

Where indicated list all relatives of the members of the Governing Body of the Charter Holder of the Governing Body of the Charter School and of the Officers of the Charter School within the third degree oconsanguinity or affinity These include your spouse and the following relations to you and to your spouse parents children grandchildren siblings grandparents great-grandparents nieces nephews aunts uncles and great-grandchildren

A Governin Bodt of Charter Holder 1 In the spaces below please list the names of the members of the governing body of the charter holder the offices held any board members relative within the third degree of consanguinity or affinity (see definition above) and any compensation or remuneration from the charter holder or charter school received by the board members

Board Name Office Held __ I the Third ~~~ Board Member UI or Affinity Who Compensation or are Also ~ on the Board Remuneration Per Year

Iris Burnham President Esther Burnham $0

Leonard Lidiak Vice President None $0

Celia M Castro Berton Secretary None $0

Esther Burnham Treasurer Iris Burnham $0

Maceo r Oailev Jr Trustee None $0

Henry Kellen Trustee None $0

2 Will any relative of the board member within the third degree ofconsanguinity or affinity (see definition above) be employed by or receive any compensation or remuneration from the charter holder or the charter school Ifyes provide details in the space provided below YES I8J NO 0 Iris uumuud is _ as the ~u ~ Wood ~U ltrh ulslIr~ Her annual is $70000 She is the mother of Esther Burnham who is employed by the charter school as Finance Administrator Her compensation is $42000 Neither person receives compensation for serving as a board member

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3 Will any board members spouse or any of the spouses relatives within the third degree ofconsanguinity or affinity (see defmition on page 3) be employed by or receive any compensation or remuneration from the charter holder or charter school If yes provide details in the space provided below YES 0 NO I8l

4 Will any person who is a relative within the third degree ofconsanguinity or affinity (see definition on page 3) of a charter school officer (ie a person charged with the duties of or acting as a chief executive officer a central administrator a campus administration officer or a business manager) be employed by or receive any compensation or remuneration from the charter holder or charter school If yes provide details in the space provided below YES I8l NO 0 Esther Burnham is Iris Burnhams daughter Esther is employed by the charter school as Finance Administrator and receives an annual compensation of $42000 Iris is the Districts Superintendent

B Governin Bod~ of Charter School 1 If the governance structure includes more than one board (ie a governing body that is separate from the governing body of the charter holder) in the spaces below please list the names of the members of the governing body of the charter school the offices held any relative of a board member within the third degree of consanguinity or affinity (see definition on page 3) and any compensation or remuneration from the charter holder or charter school received by the board members

Board Mem ber Name Office Held Relative(s) Within the Third Degree of Consanguinity or Affinity Who are Also Servin2 on the Board

Board Member Compensation or Remuneration Per Year

See Section II A I

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2 Will any relative of a board member within the third degree of consanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or the charter school Ifyes provide details in space provided below YES ~ NO D See Section II A 2

3 Will any board members spouse or any of the spouses relatives within the third degree of consanguinity or affinity (see definition on page 3) be employed by or receive any compensation or remuneration from the charter holder or charter school If yes provide details in the space provided below YES D NO ~

C Roles and Reslonsibilities of Governin Bodies Describe the roles and responsibilities ofboth the charter holder and charter school governing bodies If this represents a change from the governance structure currently on file with the Agency please indicate that it is a change and describe the difference from the previous structure

Reference Policy Manuel on governing board The School shall be governed by the Board of Directors as provided in the charter the articles of incorporation and the bylaws as applicable The Board ofDirectors of the Cbarter Holder will serve on the Board of the Charter School in addition to trustees appointed by the Charter Holder Board Members The Board shall consist ofno less than three nor more than seven members

Change The Charter Holder Board of Directors expanded from five members to a maximum of seven members

The El Paso Education Initiative Inc shall govern the operation of Burnham Wood Charter Schools with the assistance from an Education Advisory Board

D Oranizational Chart Criminal Histon Records Bioralhical Affidavit 0 Submit an organizational chart Include this document as Attachment 1 Organizational Chart 0 Submit a criminal history record for each board member Include these documents as Attachment 2 Criminal

History Records for Board Members 0 Submit a biographical affidavit for each board member Include these documents as Attachment 3 Board

Member Biographical Affidavit 9J 9

Section m Teacher Qnalifications In the space provided describe the qualifications required for all classroom teachers and other instructional staff If this represents a change from the charter application on file with the Agency or approved amendments please indicate that it is a change and describe the difference from the previous requirement

Burnbam Wood

AII professional teaching staff is required a minimum of a Bachelors Degree

Other professional non-teaching staffwill have a combination of experience andor college degrees appropriate for the position they hold

Teachers will be required to attend a minimum of twelve hours ofinservice instruction annually

CHANGES TO THE ORIGINAL CHARTER We have removed the requirement for the Kindergarten teacher to have experience in Froebel methodology All teachers will be knowledgeable on the TEKS for their classes and implement

All teachers will the T AKS in their classroom

Section IV Code of Conduct In the space provided describe the methods used to inform parents and students about school rules and guidelines governing student behavior Include policies regarding student expUlsion and suspension and procedures that satisfy due process requirements

parents a Code of Conduct Handbook during their orientation delineates policies for various infractions of the rules of Burnbam Wood Attendance policies and uniform regulations are also a part of the enrollment packet that all parents and students must sign

The Code of Conduct for Elementary School Campus includes Walking in Hallways Using soft voices in the bu ilding Exhibit appropriate behavior Respect the rights of other students Respect for teachers Respect for all school property Use proper language at all times

The Code of Conduct for the High School Campus includes Respect fur school personnel and each other at all times Exhibit appropriate behavior Respect the rights of others Respect for all school property

In addition other offenses are categorized according to the severity of the offense Category I Offenses will result in immediate suspension Category II Offenses will result in immediate removal from class Category III Offenses will result in school community services andor parent conferences

Both campuses follow state and federal regulations concerning weapons tobacco drugs and sexual harassment

All criteria for any code ofconduct in our School Policy Manual is based on The Texas School Law Bulletin

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are steps I Student is removed from class 2 Parent is called to pick up their child 3 Suspension hearing with parents student and principal Student may be suspended for I to 3 days depending on

offense 4 Hearing is conducted with parent student and principal decision may be appealed to Superintendent

Expulsions are conducted using the following steps I Student is removed from class 2 Parent is called to pick up student Police may be called depending on offense 3 Hearing is conducted with Superintendent decision may be appealed to the School Board 4 Hearing is conducted with School Board

Section V Complaints In the space provided describe the methods used to inform parents students and employees about the procedures for receiving and responding to complaints (Note Under 19 TAC sect IOOIIOI(e) the governing body ofa charter holder shall not delegate final authority to hear or decide employee grievances citizen complaints or parental concerns)

Bu rnham use an additional handbook for employees The handbooks are presented to parentsstudents during the orientation meeting Parents and students are encouraged to schedule appointments with the school Administrator in order to discuss any problems that may be occurring Additional notices encouraging parentstudent input are included on report cards and various flyers Any complaints by parents or students follow these steps

I Initially complaint goes to the teacher 2 Principal 3 Superintendent 4 School Board

Employees receive the employee handbook during their initial meeting after being hired Employee input is also encouraged The handbooks address complaints using the following steps

I Initial complaint goes to supervisor 2 Principal 3 Superintendent 4 School Board

At no time is to hear or decide left to our

parents

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Section VI Admissions Policy In the space provided describe the timeline used for admitting students including the application deadline and the process for the admission ofstudents by lottery (Although state law permits students to be accepted on a first come first served basis or through a lottery a charter school that is oversubscribed must use a lottery to be eligible to receive federal funds)

To be found on 2-13 of the original charter

Admission Policy Burnham Wood Charter School will not discriminate in its admission policy on the basis of sex national origin ethnicity religion disability academic athletic or artistic ability or the district the child would otherwise attend in accordance with Texas Education Code

Burnham Wood Charter Schools application provides for the exclusion of an applicant who has a documented history of criminal offenses juvenile court adjudication or discipline problems under TEC Chapter 37 Subchapter A Documented discipline problems include truancy fighting prior school suspension vandalism and alcohol drug or tobacco use Determination of a students documented history of discipline problems that will warrant the denial of admission will come from transfer records from prior school such as discipline and attendance records counselor notes parent information court and probation department records Burnham Wood Charter Schools will provide special advertising in Spanish and English to recruit a diverse student population Burnham Wood Charter Schools will use radio television newspaper announcements as well as mailings to military installations and various community organizations

An amendment to use the lottery system for admission was approved in January of2002 Lottery is used here by a means that when more students apply for admission than can be accommodated by the maximum enrollment students must be chosen from the pool at random for all the available spots Students already enrolled in the charter school do not have to reapply every year The lottery is held on the fourth Wednesday in March at 12 noon Vacancies which occur after the lottery has been held are filled by holding an additional lottery for those classes that have waiting lists

Exceptions to the policy are on these bases only (a) siblings of students already admitted to or attending the same charter school and (b) children of a charter schools founders (so long as the total number of stduents allowed under this exemption constitutes only a small percentage of the schools total enrollment)

Early enrollment will be held on February 15th of each year All students eligible for exceptions will be able to exercise this prerogative between February 15th and March 1st An open enrollment period will follow beginning March 1shywith the lottery being held the fourth Wednesday in March Students wanting to register at the Burnham Wood Charter School must fiU out and return the Registration Form prior to the lottery

When enrolling the student the following must be provided I Completed and signed enrollment packet 2 Birth Certificate 3 Immunization records 4 Student transcripts 5 Student academic and behavior profile 6 Proofof residency

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7 unifonn agreement 8 parent involvement agreement 9 Home Language Survey

Enrollment packets are accepted after the enrollment lottery is held and are not required to register Enrollment packets may be tnrned in at anytime prior to the stndent beginning school

Section VIT Student Performance Goals In the spaces provided below identify the schools academic goals for stndent learning for the next five years in tenns of AEIS base and additional indicators and other relevant performance information

Some accountability standards and criteria for 2004 and 2005 are available in the 2002 Accountability Manual which is available at wwwteastatetxuslperfreportiaccountJ2002manual TAKS passing standards for Exemplary and Recognized are the same as in 2002 Rating criteria and standards have not yet been detennined beyond 2002 for completion rate dropout rate the State-Developed Alternative Assessment (SDAA) and the Academically AcceptableAcceptable rating

A AEIS Base Indicators Describe stndent perfonnance goals in tenns of AEIS base indicators (ie T AAS scores and dropout rates) Be specific about indicators such as percentage of stndents passing exams and annual dropout rates Note Campuses rated under the Alternative Education Accountability system may also have student attendance and Texas Learning Index (Ill) growth as base indicators

Wood Charter high school has qualified for recognized statns ever year we were rated We expect to to be a recognized school in futnre years As accountability changes we will increase our expectations of our stndents through increased tntoring and emphasis on the TAKS elements For our base indicator ofTAAS we will have 80 or more of our students in all categories pass Reading Writing Mathematics and Social Stndies Our drop-out rate for all stndent groups will be 25 or less

The high school has moved to an Alternative Accountability Rating in the 2001-2001 school year Preliminary TAAS results indicate that it will be rated as a Commendable School

B AEIS Additional Indicators Describe student perfonnance goals in terms of AEIS additional indicators (ie attendance rates 4-year completion rate college admissions testing and participation in the recommended high school program) Be specific about indicators such as average Texas Learning Index (TLI) growth year-to-year progress and accountability ratings NoteCampuses rated under the Alternative Education Accountability system may also have campus-selected additional indicators

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District expects every student to every school on a daily Our attendance rate of all student groups within our district will be at least 96

Burnham Wood Charter School District requires all students that started their high school career with us to complete the Recommended High School Program Students who have entered our district later in their high school career will be given every effort and encouragement to graduate under the Recommended High School Program

Our local high school indicator under Alternative Campus Accountability is the ratio of the number of courses taken to the number ofcourses completed

C Other Relevant Performance Goals Describe other relevant student performance goals that may be unique to your school

expects our students to growth for 9 months school time

Section vrn Monitoring Follow-Up Discuss improvements made and other actions taken to address any and all findings recommendations or sanctions by TEA including those resulting from monitoring on-site visits or hearings Provide specific information about compliance status with all special program indicators including corrective action plans for bilingual and special education programs and about PASIDAS risk levels

We now contract a Texas Certified Speech Therapist

Special Education Referrals and ARD forms have been updated

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Part 2 Special Needs StudentslPrograms

NOTE The approval of this charter school renewal application andlor removal ofany contingencies is based on the information provided by the charter school as it reflects the charter schools knowledge of special education Approval of the charter school renewal application andlor removal of any contingencies should not be construed to reflect a determination of special education compliance or to cover any other issues outside the scope of this renewal application process or actions that may have occurred since this renewal application process

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Section IX IDEA Key Components Describe IN DETAIL (in the order requested and in the space provided below) how the charter school accommodates students with disabilities in the SPECIAL EDUCATION program according to the Individuals with Disabilities Education Act (IDEA) the Texas Education Code the State Board of Education rules and the Commissioners rules (SEE Key Components)

Please DO NOT SEND a copy of the charter schools special education policies and procedures This will only delay the review by a second request to submit the information as requested

The Texas Side-by-Side is available online to assist the application process httpwwwteastatetxusspecialedrulessbshtml

A Child Find (34 CFR 300125)

Burnham Wood District actively or delay who are 0-21 years ofage We post notices in the Burnham Wood School District building along with community-wide advertising on radio television and bench ads We identifY locate and evaluate all individuals 0-21 years ofage regardless of nature or severity of disability Once we determine eligibility all individuals 0-21 years of age regardless of severity of the disability or developmental delay are served by either the LEA [3-21 years of age] in accordance with Texas Education Code 25001 or an ECI program [0-3 years ofage](34CFR 300128 300220300300 Note 34CFR 30316 30321 and 19 TAC 891035)

B Confidentiality (34 CFR 300127 34 CFR 300560-300577 34 CFR Part 99 TEC 26004)

un( permits parents to inspect and review any education records are collected maintained or used by the agency under this part Burnham Wood complies with requests without unnecessary delay and before any meeting regarding an IEP or any hearing pursuant to 300507 and 300521-300528 and in no case more than 45 days after the request has been made The right to inspect and review education records under this section includes

1 The right to a response from participating agency to reasonable requests for explanations and interpretations of the records

2 The right to request that the agency provide copies of the records containing the information if failure to provide those copies would effectively prevent the parent from exercising the right to inspect and review the records and

3 The right to have a representative of the parent inspect and review the records Burnham Wood presumes that the parent has authority to inspect and review records relating to his or her child unless the district has been advised that the parent does not have the authority under applicable State law governing such matters as

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C Procedural Safeguards (34 CFR 300504)

An Explanation of Rights and Procedural Safeguards of a Parent with a Child with Disabilities in School explains parents rights about his or her education as outlined in federal and state law The Burnham Wood designee goes over An Explanation of Rights and Procedural Safeguards ofa Parent with a Child with Disabilities in School with the parent If there is something that he or she does not understand they may ask for further information An Expanation of Rights and Procedural Safeguards of a Parent with a Child with Disabilities in School is made available to the parent in their native language in writing or through an interpreter

An Explanation of Rights and Procedural Sageguards ofa Parent with a Child with Disabilities in School is given to parents

I Upon initial referral for evaluation of their child 2 Upon each notification ofan admission review and dismissal committee (ARD) meeting concerning their child 3 Upon each reevaluation of their child 4 Upon a school districts request for a due process hearing about their child

As an added security measure Burnham Wood has all employees with access to student records sign a confidentiality agreement

D Notice of admission review amp dismissal (ARD) committee meetings (34 CFR 300503 34 CFR 300345 TEC 260081 19 TAC 891015 19 TAC 891045)

Burnham Wood produces and provides to the parent a copy of a comprehensive easily understood document that explains the process by which an individualized education program is developed for a student in a special education program and the program and the rights and responsibilities of a parent concerning the process The document must include information a parent needs to effectively participate in an admission review and dismissal committee meeting for the parents child This includes notification ofall meetings at least five days prior to the event

The agency will ensure that each school district provides the document required under this section to the parent as provided by 20 USC Section 1415(b)

I as soon as practicable after a child is referred to determine the childs eligibility for admission into the districts special education program but at least five school days before the date of the initial meeting of the admission review and dismissal committee and

2 at any other time on reasonable request of the childs parent

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E Evaluation of children to determine eligibility (34 CFR 300530-300543 TEC 29004 19 TAC 891011 19 TAC 891015 19 TAC 891040)

A written report of a comprehensive individual assessment of a student for purposes ofspecial education services is completed not later than the 60th calendar day following the date on which the referral for assessment was initiated by school personnel The assessment is conducted using procedures that are appropriate for the students most proficient method of communication

F Development and implementation of the individualized educational program (IEP) Extended school year (ESY) services (34 CFR 300342-300350 34 CFR 300309 TEC 370021 19 TAC 891050 19 TAC 891053 19 TAC

891055 19TAC 891065)

Before a child is enrolled in a special education program Burnham Wood establishes a committee composed of the persons required under 20 USc Section 1401 (20) to develop the childs individualized education program The committee develops the individualized education program by agreement of the committee members or if those persons cannot agree by an alternate method provided by the agency Majority vote may not be used to determine the individualized education program

If the individualized education program is not developed by agreement the written statement of the program required under 20 US C Section 1401 (20) must include the basis of the disagreement

If the childs parent is unable to speak English the district I provides the parent with a written or audiotaped copy of the childs individualized education program translated into

Spanish if Spanish is the parents native language or 2 if the parents native language is a language other than Spanish make a good faith effort to provide the parent with a

written or audiotaped copy of the childs individualized education program translated into the parents native language The need for Extended School Year Services is determined by an ARD Committee on an individual case-by-case basis based on documented need for such services as shown by formal andor informal assessments In order to qualiry for ESY services a student with a disability must demonstrate that heshe will likely experience a severe or substantial regression during the summer in one or more critical areas of the IEP if ESY services are not provided The reasonable period of time for recoupment of the acquired critical skills is determined on the basis ofneeds identified in each students IEP If the loss of acquired critical skills is particularly severe or substantial or if such loss results or reasonably may be expected to results in immediate physical harm to the student or others ESY may be justified without consideration of the time period required for recoupment In any case the time period for recoupment of critical skills does not exceed 8 weeks For students enrolling in Burnham Wood during the school year information from the prior school as well as information collected during the current year is used to determine eligibility

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G Least restrictive environment (LRE) placement (34 CFR 300550-300553 19 TAC 8963(a-craquo

Burnham Wood ensures I that to the maximum extent appropriate children with disabilities including children in public or private insitutions

or other care facilities are educated with children who are nondisabled and 2 that special classes separate schooling or other removal of children with disabilities from the regular educational

environment occurs only if the nature of the severity of the disability is such that education in regular classes with the use of supplementary aids and services cannot be achieved

H Transition planning (34 CFR 30029 TEC 29011 19 TAC 891110)

Burnham Wood School District develops and annually reviews an individual transition plan (ITP) for each student enrolled in a special education program who is at least 16 years of age The ITP is developed in a separate document from the individualized education program (IEP) and may not be considered a part of the IEP The school district coordinates the development of the ITP with any participating agency as provided in the memorandum of understanding in order to provide continuity and coordination of services among the various agencies and between the ITP and IEP The district requests the participation in the development of the ITP of any participating agency recommended by school personnel or requested by the student or the students parent The district invites the student and the students parents or guardians to participate in the ITP Only those components of the ITP that are the responsibility of the district may be incorporated into the students IEP

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I Certified personnel for the provision of services to children with special needs (34 CFR 30026 34 CFR 300136 19 TAC 891131 SBEC requirements)

(a) All Burnham Wood special education and related service personnel are certified endorsed or licensed in the area or areas of assignment in accordance with 34 Code of Federal Regulations (CFR) 30023 and 300136 the Texas Code (TEC) 2100221003 and 29304 or appropriate state agency credentials

(b) A teacher who holds a special education certificate or an endorsement may be assigned to any level of a basic lspecial education instructional program serving eligible students 3-21 years of age as defined in 891035(a) of the title (relating to Age Ranges for Student Eligibility) in accordance with the limitation of their certification except for the following

I Persons assigned to provide speech therapy instructional services must hold a valid Texas Education Agency (TEA) certificate in speech and hearing therapy or speech and language therapy or a valid state license as a speechlanguage pathologist

2 Teachers holding only a special education endorsement for early childhood education for children with disabilities are assigned only to programs serving infants through Grade 6

3 Teachers assigned full-time to teaching students who are orthopedically impaired or other health impaired with the teaching station in the home or a hospital are not required to hold a special education certificate or endorsement as long as the personnel file contains an official transcript indicating that the teacher has completed a three-semester-hour survey course in the education of students with disabilities and three semester hours directly related to teaching students with physical impairments or other health impairments

4 Teachers certified in the education of students with visual impairments are available to students with visual impairments including deaf-blindness through one of the Burnham Wood School Districts instructional options a shared services arrangement with other school districts or an education service center (ESC) A teacher who is certified in the education of students with visual impairments must attend each admission review and dismissal (ARD) committee meeting or individualized family service plan (IFSP) meeting of a student with a visual impairment including deafshyblindness

5 Teachers certified in the education of students with auditory impairments are available to students with auditory impairments including deaf-blindness through one of Burnham Wood School Districts instructional options a regional day school program for the deaf a shared services arrangement with other school districts or an ESC A teacher who is certified in the education of students with auditory impairments must attend each ARD committee meeting or IFSP meeting of a student with an auditory impairment including deaf-blindness

J Services to expelled students (34 CFR 30012I(d) 34 CFR 300522 TEC Chapter 37 - 10 day rule)

At Burnham Wood the placement of a student with a disability who receives special education services may be made only by a duly constituted admission review and dismissal committee A student with a disability who receives special education services may not be placed in alternative education programs solely for educational purposes if the student does not meet the criteria for alternative placement in Section 37006(a) or 37007(a) (I) Burnham Wood does not provide services during periods of removal under 30052(a)(l) to a child with disability who has been removed from his or her current placement for 10 school days or less in that school year (2) In the case ofa child with a disability who has been removed from his or her current placement for more than 10 school days in that school year Burnham Wood for the remainder of the removals

(i) provides services to the extent necessary to enable the child to appropriately progress in the general curriculum and appropriately advance toward achieving the goals set out in the childs IEP the criteria is as follows

(a) removal for not more than 10 consecutive school days as long as that removal does not constitute a change of placement under 300516(b) 300520(a)(I) or

(b) for behavior that is not a manifestation of the childs disability consistent with 300524 and (ii) provide services consistent with 300522 regarding determination of the appropriate interim alternative educational

setting if the removal is shy(a) for drug or weapons offenses under 300520(a)(2) or (b) based on a hearing officer determination that maintaining the current placement of the child is substantially

likely to result in injury to the child or to others ifhe or she remains in the current placement consistent with 300521 (3) School personnel in consultation with the childs special education teacher determine the extent to which services are necessary to enable the child to appropriately progress in the general curriculum and appropriately advance toward

achieving the goals set out in the childs IEP if the child is removed under the authority of school personnel to remove for not more than 10 consecutive school days as long as that removal does not constitute a change of placement under 300519300520(a)(I)

(ii) the childs IEP team determines the extent to which services are necessary to enable the child to appropriately progress in the general curriculum and appropriately advance toward achieving the goals set out in the childs IEP if the child is removed because of behavior that has been determined not to be a manifestation of the childs disability consistent with 300524

K Allowable expenditures of state special education funds (19 TAC 891125)

(a) Persons paid from special education funds are assigned to instructional or other duties in the special education program andor to provide support services to the regular education program in order for students with disabilities to be included in the regular program Support services include but not limited to collaborative planning co-teaching small group instruction with special and regular education students direct instruction to special education students or other support services determined necessary by the admission review and dismissal (ARD) committee for an appropriate program for the student with disabilities Asssignments may include duties supportive to school operations equivalent to those assigned to regular educaation personnel (b) Personnel assigned to provide support services to the regular education program as stated in subsection (a) oflhis section may be fully funded from special education funds (c) Ifpersonnel are assigned to special education on less than a full-time basis except as stated in subsection (a) oflhis section only that portion oftime for which the personnel are assigned to students with disabilities are paid from state special education funds (d) State special education funds may be used for special materials supplies and equipment which are directly related to the development and implementation of individualized education programs (IEPs) of students and which are not ordinarily purchased for the regular classroom Office and routine classroom supplies are not allowable Special equipment may include instructional and assistive technology devices audiovisual equipment computers for instruction or assessment purposes and assessment equipment only if used directly with students (e) State special education funds may be used to contract with consultants to provide staffdevelopment program planning and evaluation instructional services assessments and related services to students with disabilities (I) State special education funds may be used for transportation only to and from residential placements Prior to using federal funds for transportation costs to and from a residential facility Burnham Wood School District must use state or local funds based on actual expenses up to the state transportation maximum for private transportation contracts (g) State special education funds may be used to pay staff travel to perform services directly related to the education of eligible students with disabilities Funds may also be used to pay travel of staff (including administrators general education teachers and special education teachers and service providers) to attend staffdevelopment meetings for the purpose of improving performance in assigned positions directly related to the education of eligible students with disabilities In no event shall the purpose for attending such staffdevelopment meetings include time spent in performing functions relating to the operation of professional organizations In accordance with 34 Code of Federal Regulations 300382(j) funds may also be used to pay for joint training of parents and special education related services and general education personnel

CFR~Code of Federal RegulatIOns TEC-Texas EducatIon Code TAC-Texas AdministratIve Code

20

A Current copy of the charter schools infonnational brochurepamphlet

B Current blank copy of the initial pre-selection data sheet for potential students - the fonn or student infonnation requested for the charter schools admission method (ie lottery etc)

C Current blank copy of the student enrollment card once the student is selected for enrollment in the charter school

D As part of Attachment 4 provide a brief description of the charter schools instructional arrangementssettings (mainstream resource roomservices self-contained etc) implemented for the provision of special education and related services This description is not limited to but must include infonnation on the location of services (in relation to the general education setting) and the staffing of personnel

If the charter school has students with disabilities receiving special education and related services in the instructional arrangementsetting ofmainstream then provide infonnation on the provision of support services by qualified special education personnel

Currently if the charter school has no students with disabilities receiving special education and related services then provide infonnation based on previous school years If the charter school has never had students with disabilities receiving special education and related services then provide infonnation based on the possibility of the enrollment ofa student with a disability that would receive special education and related services in the various special education instructional arrangementssettings

E As part ofAttachment 4 provide a brief description of the charter schools system for placement decisions with transfer students that previously received special education and related services from another districtcharter school in any instructional arrangementsetting EXCEPT mainstream

If the initial placement prior to the 30-day transfer ARD is a mainstream instructional arrangementsetting provide a detailed explanation for this decision

For further on X Requests contact in the Division of

Special Education (512-463-9362)

1 Jshy

21

Attachment 1 Organizational Chart

JjurnfJam mloob ~bi1rttr~cboor

Organizational Chart

Board of Directors

I Superintendent

Principal I

Administrative Bookkeeper Assistant

II

High School Site Manager

I

Educational Consultant

I

High School Teachers and

Staff

Elementary Teachers

Finance Administrator

r Maintenance Staff

I

Office Staff

-shyr (

Attachment 2 Criminal History Records for Board Members

Criminal History RecordsBackground

PAGES 25 - 30 = 6 PAGES

6 PAGES HAVE BEEN WITHHELD UNDER SECTIONS 4110845 AND 4110901 OF THE GOVERNMENT CODE

Attachment 3 Board Member Biographical Affidavits

1 bull u

TEXAS EDUCATION AGENCY OPEN-ENROLLMENT CHARTER SCHOOL APPLICANT

BIOGRAPIDCAL AFFIDAVIT (Attachment 3) (MUST BE TYPED and NOTARIZED)

Check all that applyI8l Member ofthe governing board of the charter holder I8l Member ofthe governing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 121012

Full Name of Charter Holder (ie nonprofit corporation institution of higher education or governmental entity) El Paso Education Initiative Inc

Full Name of Charter School Burnham Wood Charter School

In connection with the above-named organization and charter school renwal application I herewith make representations and supply information about myself as hereinafter set forth (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully)

IF ANSWER IS NO OR NONE SO STATE

l Full Name (Initials Not Acceptable) Esther Lee Burnham

2 Have you ever had your name changed or used another name No

Ifyes give reason for the change __________________________

bMaiden Name (iffemale) Burnham

c Other names used at any time __________________________

3 Social Security Nurnbeq

4 Explain any compensation that you expect to receive from your association with the charter holder the charter school or a management company ofthe school

PosmON COMPENSATION

Administrator Operations and Development $42000

No compensation is received from serving as a board member

5 List all previous experience with charter schools Include open-enrollment schools andor campus or program charters

DATES EMPLOYER ADDRESS TITLE

211802 - present Burnham Wood Charter School 7310 Bishop Flores EI Paso TX 79912 Administrator Operations and Development

List all previous experience with any charter school management company


No previous experience

6 Will you or any relative within the third degree of consangninity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the charter holder or the charter school Yes Ifyes give details Iris Burnham Superintendent is my mother and receives compensation from the charter school for serving as the District Superintendent

7 Will your spouse or any ofyour spouses relatives within the third degree ofconsanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the charter holder or the charter school No Ifyes give details

8 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency No

If yes give details _______________________________

Dated and signed this 31st day ofMay 2002 at EI Paso Texas I hereby certify under penalty ofpeljury that I am acting on my own behalf and that the foregoing statements are true and correct to the best ofmy knOWle~~

(Signature ofAffiant)

State ofTexas

County ofEI Paso

Personally appeared before me the above named 511t( dCeN z1 rn personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhisJher knowledge and belief

Subscribed and sworn to before me this _30_____ day of 171- Y 20 t2 2shy

pound~~~UolMARY JO MITCHEL bull bull NOTARY PUBLIC

-1lJ Jd4 ~ ~ lt bull

0 lt Slate of Texas

Com(SmP-18-2004 My commission expires 3 - - t 7


BIOGRAPHICAL AFFIDAVIT (Attachment 3) (MUST BE TYPED and NOTARIZED)

Check all that apply r7LMember of the governing board of the charter holder 0 Member of the governing board for the charter school


GZl School officer President of the Board of Directors State Position as defined in TEC 121012

Full Name of Charter Holder (ie nonprofit corporation institution of higher education or governmental entity) _EI Paso Education Initiative Inc_

Full Name of Charter School _Burnham Wood Charter School



I Full Name (Initials Not Acceptable) Iris Barbara Burnham

2 Have you ever had your name changed or used another name Yes_

a If yes give reason for the change marriage

bMaiden Name (iffemale) Kemler

c Other names used at any time None

3 Social SecurityNumber~

4 Explain any compensation that you expect to receive from your association with the charter holder the charter school or a management company of the schoo

POSITION COMPENSATION

Superintendent $70000 annual salary

5 List all previous experience with charter schools Include open-enrollment schools andlor campus or program charters


None



None

6 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the charter holder or the charter school YES_ If yes give details Daughter works as grants administrator

7 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the charter holder or the charter school NO_ fyes give details _______

8 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency NO__

fyes give details ________________________________

Dated and ~ignejhis 31- day Of_Lj1----7~f--L___________ 20 L at LI lt) I eQt 5

I hereby certify under penalty of peljury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge rid beld 1

-h=gt 0 ( J-u-r~ ~ -shy(Signature of Affiant)

State of -T_middote--)lt-f5______

County of 11 Ale )

Personally appeared before me the above named--r--r--I--S----lelt--6=-l-Y ______-----shy-ltcJ-~__ personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this -~---_____ day of jJ7-f Y 20 02

c$feM 0 --1--t-c~~~bullbull~u(O MARY JU MITCHEL (Notarylgttlic)

f71 bull NOTARY PUBLIC S~ fl as My commission expires 3 - j S -dcJ(~ CIn ~glb~j82004

~ bull I



Check all that applyxD Member of the governing board of the charter holder xD Member ofthe governing board for the charter school


xD School officer


Full Name of Charter Holder (ie nonprofit corporation institution of higher education or governmental entity)

El Paso Education Initiative Inc___

Full Name of Charter School

Burnham Wood Charter School___



I Full Name (Initials Not Accepta ble) __Leonard Lidiak __

2 Have you ever had your name changed or used another name _No_

If yes give reason for the change __

bMaiden Name (iffemale)_

c Other names used at any time __

3 Social Security Number ____

4 Explain any compensation that you expect to receive from your association with the charter holder the charter school or a management company of the school


Director and Vice Preident None



1998 Burnham Wood Charter School EI Paso TX Advisory Director



None

6 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the charter holder or the charter school _No If yes give details ____________________

7 Will your spouse or any of your spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the charter holder or the charter school _No If yes give details _____________________________________

8 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency __No_

If yes give details ________________________________

Dated and signed this _30th_ day of __May__ _2002__ at EI Paso Texas I hereby certifY under penalty of perjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief

~ (~~

(Signature of Affiant)

9u

State of TEXAS___

County of ELPASO__

Personally appeared before me the above named_LEONARD LIDlAK__personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best of hisher knowledge and belief

Subscribed and sworn to before me this _30th_ day of _MAY_ _2002_

Cv~ ~q ~I(Notary Public)

(SEAL) My commission expires 04072006

MARIA ALMA DIAZ NOTARY PUBlIC

In Stat ofT lIy_expm

()407middot2006

OJ 0



Check all that applyIX Member ofthe governing board ofthe chaiter holder mMember ofthe governing board for the charter school

It should be understood that a board members resignation may not be effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board o School officer


Full Name of Charter Holder (ie nonprofit corporation institution of higher education or

gOVErfgt~~ity)E cLu C 0- middoth lt=gt h I-~ tcfi_1Hc

Full ~e of Chafer School _1Lc1-ic(u=---=--(-n---t1A~-=--U=--O_O---=G---cJ=-gtl--~J+~cr ~ C [ DC



1 Full Name (Initials Not Acceptable)

2 Have you ever had your name changed or used another name __Y-E-=---_ Ifyes give reason for the chaoge M~ lrYMf ~sect 10 Lc NC +

H rNocj ~oCf(o Le-t~GeuroA bMaiden Name (iffemale) ___________--________________

c Other names used at any time ___

3 Social Security Number ______=



NA

LL eYJ

i)middotr 1

beliet--_





7

6 Will you or any relative within the third degree ofconsanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the charter holder or the charter school N C) Ifyes give details ____________________

7 Will your spouse or any ofyour spouses relatives within the third degree of consanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the charter holder or the charter school V-o Ifyes give details

8 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement ofa sentence suspended or been pardoned for conviction ofor pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject ofany disciplinary proceedings of any federal or state regulatory agency 1(bull

Ifyes give details _______________________________

Dated and signed this J day of __(1__J_Jv---t____~______--- 20 0 ~ ru -~~~--~~-~~~~-~~---~~~-77-~-------shy

I hereby certify under penalty of perjury that I am ac g on my own be and that the foregoing statements are true and correct to the best f my knowledge an

State of _-_e__A_~---__)

I I

County of f LfJMAgt Personally appeared before me the above named kGj klIIe personally known to me who being duly sworn deposes and says that heshe executed the above instrument and that the statements and answers contained therein are true and correct to the best ofhislher knowledge and belief

Subscribed and sworn to before me this ~ 20 Q~

JLGOMEZ MY c~~I~S~ON EXPIRES (S~2005 My commission expires j--

uJbS

--------------------------------



Check all that applyxD Member of the governing board of the charter holder xD Member of the governing board for the charter school

It should be understood that a board members resignation may not he effective until a replacement is duly appointed by the board and a board member may be personally liable for any actions taken by the board

o School officer

State Position as defined in TEC 1210 12

Full Name of Charter Holder (ie nonprofit corporation institution of higher education or governmental entity) EL PASO EDUCATION INITIATIVES

Full Name of Charter School BURNHAM WOODS CHARTER SCHOOL



IFuli Name (Initials Not Acceptable) CELIA MARTIIA BERTON_____________________________________

2 Have you ever had your name changed or used another name _YES____

Ifyes give reason for the change MARRIAGE ____________________________

bMaiden Name (iffemale) CASTRO _______________________

c Other names used at any time ____________________________

3 Social Security NllmlJer


POSITION COMPENSATION NA_______________________________


DATES EMPLOYER ADDRESS TITLE NA___________________________________________________________


DATES EMPLOYER ADDRESS TITLE NA______________________________________________________________

6 Will you or any relative within the third degree of consanguinity (ie parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the charter holder or the charter school __NO Ifyes give details ______________________

7 Will your spouse or any ofyour spouses relatives within the third degree ofconsanguinity (ie his or her parent grandparent great-grandparent child grandchild great-grandchild sibling aunt uncle niece nephew) be employed by or receive any compensation or remuneration from the charter holder or the charter school ____NO If yes give details __________________________________________

8 Have you ever been convicted or had a sentence imposed or suspended or had pronouncement of a sentence suspended or been pardoned for conviction of or pleaded guilty or nolo contendere to any information or indictment charging a misdemeanor involving moral turpitude or any felony or have you been the subject of any disciplinary proceedings of any federal or state regulatory agency ____NO_________

If yes give details ______________________________

02lIIIIIIIIIJated and signed this 5th day of June 20____ ~$iAlls2rf~t El Paso Texas -U L El Paso

rSVPii8ffJf(ftpJ certify under penalty ofperjury that I am acting on my own behalf and that the I (~~Or1deg1g statements are true and correct to the best ofmy knowledge and belief

~~~~ ~~~ ~ -bullbull tt-OF~ l ~ (Signature of Affiant)~ bullbull fXPlRt~middot ----7 middot3-middotmiddotmiddot~~middot=~twof GX4S

~III 19-~ ~ ==-----------shy1111II1II11I1I~t)clfJTtf p ecPA 5 0

I t 5 6~joL-

-----------------------------------------

a5312aa2 1559 9155858814 5EE SCHOOL PAGE a2


IOGllAIIDCAL AlTIDAV1T (AttKh_ 3) (MtIST BE TYPED aIId NOTA1UZED)

C1IedIIIII that apply D M~m~~~~~~~~ ~ MImber oftile JOIIIlIIiIri boIld for tile chartlaquo IIlbooi

IlI1bouId be UBdemood dIat bull board member zeaignation may DOt be cffictivc until a ~I is cllIy appciDIod by the board aDd a board member may be persoaaIJy liable fOr l1li) ax- takality the board o ScbooI ofticer

Sw POilitioll u dofiacd ill TEe 121012

hiN_ IIICIIarter Holder (Ie IIOliprolit eorpor8tioa iutitutioll of hill- education or

111 taleMicy) Burnham Wood Charter School

N N_elQarier ScIIMI Burnham Wood Charter School

Ia c_ ctiaI witl1IIe 0 MIIIICd lIiliOll aDd charter xbool reowal applicetiM r hcrcwitb make em rtiou and IUppIy iafOnDatiOll about myaolf u hereiDaampr forth (Aucb add um or eo thDot ifspace berootI is illllufficiODt to _ aay quedioaI thIIy)

IF ANSWEaIS NO OR NONE SO STATE

I 11111 ~ (IaiciaII Not At ~)____________~M~a~c~e~o_C~rue~n~sect~b~aw~p~aj~Je~Yw~J~r~____

2 Have you ever IIad your MIlle middotIIv or uled aaorIIer _1___N_o__

Itycsbullbullw_fer_____________________

bMai0e8 N_ (if)

c 0tW _1IIOIId II in _________________________________

3 Social SecariyNIItIIbor ~_____________

4 ExpIaiD aay ltampcMrion that you cxpoc to receive from your auociatioD with the ebamr holder iIIe clIarI=o ICbooI or a manaaement company oftbemiddothool

POSmoN COMPENSATION Board Member None

9155858814 SEE SCi-iooL PAGe 133

S Lilt all pteriolu cxpe~ vtb charter scbooI ladude opeu-earollrnent sdIoob aadlor CIIIIIPIl at prncrua dIaa1crs


o

11 e

DATES EMPLOYEll ADDRESS TITLE

N o

n e

6 Will you or MY reIIIIM withia tloe IiIird desree ofrmsanguillity (ie pareot ~ arcat~ child pandcbiId JIWI1idild ibw ampWIt WICle m- aepbow) be Cllllflloycd by Ol ftlCCIivc --Mtioa or reIIIIlIIeIaIi figm the cbutcr bolder or thecIIu1er aehcot7 No Ifyet live detaiiI __________________

bull Have you over baa CCIIIVicted or had A seareGCe Unposed or suspcllded or hid prQIlIltJlICCmcal ofIteoce 1IIfIIIIded or beaI patdoIIcd for rmvietioD ofor plcllded guilty or DOlo conaeeclen to lIlY iDmrmItioa or indietment charaing a misdemcaIIor involw moraI lIDJIilude or lIllY feJoay or hsve ycu baa be subject ofaay disciplinary prcyeecMp cilD) fedenI or ~1IjICIII)_~yes____

liyee sWe ckItampilI Student Protest Moement in Call 989 Charges were dropped

S~Of _____T~e~x~a~s~______

7 J~

0612~062 1226 9155858814 SEE SCHOOL PAGE 64

Countyof ~th-() PmoDI1Iyappeared bein me die above nama lhCLUJ) rJ ~tlt~ cp shypnaMIIy kDDwllro _ who beiaamp duly sworn depocs aDd 5a)l that bIIIsbe ~tai lIbove ~ ud tbd die ~ ud auwcn contaiDed 1berCiII true t colTCCC to be beat of~r Iaiowk We_ IIoIiepound

JACKIE DEARMAN MY COMMISSION EXPIRES

NovemborfSlilU-) y~~~------------

Attachment 4 Special NeedslPrograms Information Request

Attachment 4 Special Needs StudentslPrograms Information Request

A Current copy of Burnham Wood Charter School District brochure attached B Current copy of Burnham Wood Charter School District enrollment packet with

home language survey card attached C Current blank copy Burnham Wood Charter School District enrollment card

attached D Description of Burnham Wood Charter School District instructional arrangements

for special education and related services Burnham Wood Charter School District provides mainstream settings for

many of our special education students We also provide pull-out resource classes if needed Our students are provided speech therapist services along with certified Special Education teachers who work with the regular education teachers Special Education teachers provide assistance in implementing the IEPs within the regular setting Students are also provided counseling on an as-needed basis or with recommendation from any person involved in the education of these students

E When a Special Education student that was not mainstreamed transfers into Burnham Wood Charter School District Burnham Wood provides a continuum of settings that range from resource to mainstream classes An ARD committee reviews the students existing IEP and makes a recommendation to either place the student in a pull-out program or mainstream classes

AI IV

c8ur jfIUUUp

Iris Burnham is our superintendent and founder

She has over 30 years ofexperience as a teacher

curriculum developer and administrator She is

certified to teach in New York California and

Texas Our principals are educators with over

25 years of teaching and administrative experishy

ence

Our faculty is comprised of dedicated individushy

als each bringing their own particular talents and

~xperiences

For more information visit our website at

httphomeelprrcomlburnhamwoodschl or call 915-584-9499

AI

iV)

~ C

IV

~ ~ 0 ~~~~l~~ 0OS t--o ~~

~ ~g C~ llE-t rmiddotmiddot t~-~1ltJ

~s _ lJfl1 Ifv~~ ~~~

AJ

T

1iumbamoob CJarttr~dJool

I

4sectrrat JiltmIIam mIIIoob to bllJ Jl~ bill nlJaU UJltlt

~Macbeth Act IV Scene J

4amp v

--------~~--~~~~

Wit ~t qeltasomiddots jflst eurobarttr ~tbool

We Jfe an independent public school of choice The

eh ter School is nOh-sectarian follows all rules

gOY -rning civil rights and health and safety issues

TIl Igh we are allotted per student tax dollars for

opel lting revenue we must generaleadditional fundmiddot

jng IJrollgh state and federal granl foundations and

throllgh the generosity of the EI Paso community

BUfnham Wood opened its doors in August of 19

with both an elementary school on the westside nd

a hihschool on the eastside of EI Paso

-bo ~ ruttnb1

Any student residing i~ t~e~1 PasoCanutillo Y sicta

or ~ocorro Indepen~~nfSchoql districts is eligible

to apply Applicati611S ar~ i1abie andaceepterl on

a first-come-first-serve basis The BlII11ham Wood

Chrter School will not discriminate onits adonisshy

SiCHI policy on the basis of sex national origin

ethnicity religion disability academic or athletic

ability or the district the child would otherwise atshy

tend in accordance with the Texas Education Code

_at iU em jIliUsonl

We beli~ve that we mnst work in harmony with famishy

lies artdourcotilmunity io help children accept responmiddot

sibility fOr their own learning We offer a framework

hat will eruowage lifemiddot long learning with skills knowlshy

edge creativitYaense of self-worthandothical valshy

ues each child wiilneed in the 21~t ~etury Bwnham

Wood graduates will he thinking citi ns of the fushy

ture

We believe

Each child can leom

Learning is a lifelong process

Success promotes more success

Working cooperatively is essential to prepare for a

competitive world

Family involvement is essential in the educational

process bull Creating better education requires taking risks

Cultural diversity enhances a childs education

A positive supportive safe environment is

essential

~ ~d I)

~l

c9ur 1ornmla for ~uutSS

We follow Texas Education Agencys Essentials

of Knowledge and Skills (TEKS)

Our students will fulfill all academic requireshy

ments including Reading Language Social

Studies Science Math Music Physical Fi~ness

Art Speech and Computer Literacy We teach

cooperatively and employ a Great Books Semishy

nar format as well

em IfltmtntaQl ~tbool

We are committed to offering Kindergarten

through Fifth Grade Fourth grade will be added

in 2001-2002 nd Fifth grade in 2002-2003 We

are EI Pasos only recognized Core Knowledge

Curriculum school A middle school is being

planned

em ~tg1J ~dJool Our high school students in tbe ninth through

twelfth grades receive a hwnanities based bull dushy

cation that fosters an appreciation of OUT planets

diverse cultures and their contributions to adshy

vancement of world civilization Our cunicushy

lurn integrates m~th science literaturehi~(ory

art and language to promote understanding of

ow world today

---------~--------

j[ilurttbam Moab QCbartet ~tbo~l 7310 Bishop Flores El Paso TX 79912 m--A~ (918814IJJ U-T ( ~) _~_-

REGISTRATION FORM ------------------------- Students Last Name First Name Grade Entering in August 2002

Address

MOTHERS INFORMATION

State Zip Code Home Telephone Nu~ber

Last Name First Name Middle Name Home Telephone Number

Address (if different from childs) State Zip Code

Name of Employer

FATHERS IlIFORMATION

Work Telephone Number Mothers pagercellular

ast ~ bull First Name Midile Name Home Telephone Number


ar 0f Employer Work Telephone Number Fathers pagercellular Telephone ___________With whom does your child live __________________

Previous schools attended =________________ Name AddresS

Name Address

- -- - shy

1-

~ -

bull bull~ ~ -

y ~ ~-lt~~ ~

~

bull - ~ ~

~ ~

In case you cannot be reached in an emergency please list that we should contact Name Telepbone Relationship

Name of person who is registering the child -~ - --

Relationship to student Date of Birth of person registering the child

Address City ST ZIP

ParentGuardian Signature Date

-~ -- -~----- --- 7---shy

~ ~ i~gt~ r~ __

bull -shy shy

0 lt

~ ~

-

-r -

- - i shy

1

c J~

cmiddot

~

jjurnbam oob(Cbarter ~cbool 7310 Bishop Flores EI Paso TX 79912

(915) 584-9499 bull Fax (915) 585-8814

First Name (Jrnde Entring in August 2002 ___~

Thank ynu for r~gistering at Burnham WDOU (~harler School ~ Please v is it our websit~ burnhamwoodcharterk 12 txt1si Actachtd is th~ enrollment packet Please complctl both sides oCthe yellow enrollment card Enrollment is not complete untit at the information has been rectived ClIJn1 your references and the official school records have been received

~=-~~ ~-~-~~~ ~-~~c~--~~~~

iAdmission Policy Burnham ood Charter Schools will not discriminate in its admission policy on the basis )( sex national origin ethnicity religion disability academic or athletic ability or the district

Ii the ch~d~Vouldotherwlse atlend in accordanc~~it~h~T~e_x_a~s~E~d~l~lc~a~t~ile)n~~C=(_)d=c~~~~___~~~~~c

hen you retum your enrolhnenl packet please have the following bull Copy of Birth Cel1ificate - the certificate issued by the hospital is usually not an official birth certificate and we

cannot accept it unless it has the official count) stamp bull Cop of Social Security Card -- if the student does not have a social secLlrit) card a State number will be assigned

by the school office bull COP-i of the current imt1~ut1izations Please check with your doctor to make sure all immunizations ale currellt bull llrooi of Residency -- The school 111 list have proof that you reside in Texas Pease provide a copy ofa utility bill

that showS the service address - not just the maiiing address If you do not hJve a utility bill please provide a rental agreement prope11y deed or other document that proves where you live

bull ithdrawal Form from previous school

We will fax the previous school for records but you can expedite the process by having these records at the time of enrollment

bull Discipline records bull Attendance records (sorne school will have this on the withdrawal form) bull TAAS scores (some school will have this on the vithdrawal fOlm) bull Latest report card and copy of cumulative grades Current transcript for high school students bull Copies of any assessment reports such as special education 504 bilingual talentedgifted dyslexia etc

Texas requires us to have an enrollment lottery which will be held on March 2th Please try to have all documents to us by that time Returning students siblings of current students and children of staff are exempt from the lottery After the lottery is held you will be mailed- an acceptance letter Those not selected in the lottery will be placed on a waiting list After acceptance you may pick up a uniform catalog supply list and school calendar

Studellb regist(ring after the lottery will be admittd on a first come_ first serve basis based 011 availability of space

FOR OFFICE LJSE ONLY

o Sibling of returning student o Child of staff member

Date enrollment receivcd _____~__ Time enrollmenr received _______ Enrollment null1ber____

~~~~~-~~

[J New student [J Student registered by lottery dme_ Grade ____ Lottery _~~~_

o Student registered after lottery date

Date enrollment reccived_______ Time enrollment received ______ Enrollment number____

-----~-~

Page 1 of 13 BW ENR IJ(JI IIV 021 ~lJ2

I

1Jjurnbam oob ([barter f5gtcbool FAMILY INFORMATION

STUDENT INFORMATION

----------------------_-------shyLast Name First 1ame Middle Name Age Date of Birth

State Zip Code AdJress

Grade Entering in Augusl 2002 _______~__

Ho-ne r eepholllt i Social Security Number Age of child as of September I 2002 ____

School of Residency Nallie ofhe ~cllOOI your child would be attending for the 2002lt2003 school year ifheishe were artendillS )vllr klea public 5chool_ __ ___________________~__ ________ thai is in the _______________ ____district

Student Ethnicit) Please choose the swdcnts ethniclty This is required for entering the student in the Texas PEIMS databal~ Check the ONE that best describes the students ethnicity

1 American Indian or Alaskan Native 4 Hispanic l Asian or Pacific Islander 5 White not of Hispanic Origin 3 Black not of Hispanic Origin

PARENTGUARDIAN INFORMATION

MOTHERGUARDIAN

- -------------o-~~ Last Nall1o First Name Middle ~atne

-c--------------- shyHome Telephone Number

_------ shyAddress (if different from childs) State Zip Code

Nanle of Employer Occupation

Work Tdephont Number Mothers pager number Mothers cellular number

E-1ail Address ______ Highest Degree Earned ~ ~__________

FATHERGUARDIAN

Last Naillt First Name Middle Name Home Telephone Number

- shy ---------~--c-~__-~

Address (if different Ii-om childs) State Zip Code

Name 0[ Employer Occupation

-------- shyWork Telephone Number Fathers pager 11umbcr Fathers cellular number

E-Iail Address Highest Degree Earned _____ _____

FAMILY INFORMATION

Are parents M(lrried__ Divorcect__ Widowed With whom does the child live

Has the family qualified in the past for the FreeReduced Breakfast and Lunch Program 0 Yes 0 No

Page 2 of 13

bullbullbullbullbullbullbullbullbullbullbull



------

jjurnbam oob ((barter ~(bool HOME LANGUAGE SURVEY (CUESTlONARIO DEL IDIOMA HOGARENO)

~all1e 0 the Child (Nombll y 3pcliido)

Campus ____~~____~_________~~______________ Grade (bellel) (N ivcl)

What l(tllgLl~ige is spoken in yom horne most of the time ((Cwli idiolTW se habla 1mb en su hogar)

Vhallallguage docs the studenr sPeak most Ifthe time _~____~_____ ____ (tCul idillllJa habla e1 alumna)

Parent(juardian Signature (Finna del Padre 0 Tutor) Date (Feeh)

NOTE Appropriate testing as mandated by State regulations will be administered to students ho have a Linguag other than English on their Home Language Survey

rOTA lJe acuerdo COil los reglamentos dt1 estado y las rcspuestas obtenidas en este cucstionario los alunlnos que hablcll otro idiom3 que no sea ingles debenil1 tomat lIll examen para determinar su habilidad de hablar y entender inglcs

Lst all schools your child has attended and the dates of attendance

Dares of Attendance =-~~----

~_-~__~~~~-_-_---=-=------=-----~~~-~_+_~~-----~~~-- ------------~-_i

I I l L _____Ll d ___________~

Current special programs assisting student - please circle

Special Education 504 BilingualESL TalentedGifted At Risl LEP Dyslexia

Recent Testing LAS School Date Level

TAAS Date_~_________ V1ath~~__ Reading_______ Vriting

Dysleiltl Tester_____ ~___~___________ ~~ Date Leve-l

Psychological Tester____ Date___________

Physical Tester Date___________--------- _ --------- shy

Vision Tester___ Date Level

Hearing Tester___ Date Levcl____ -------~~~

Page 3 of 13

Jr- shy

----------

--------------

Jjurnbam Woob ((barter ~(bool EMERGENCY CONTACT FORM

I-irs Naille

Emergency Contact Information Please indicate the persoll(s) who Ciln piclup your child ir the parentguardian ~Innot be reached PLEASE be complete and accurate with this information Indlldc worl cell and pager numbers The parentsguardiHlls listed 011 page 2 will he contacted first and then fhe emergency contacts will be called

I Rc1l1ionhip ) child

City Zip

oork Tckpilol1lt Cellu~lrPaglr Number

2 -----_-- -----------shyRdmitlilship In child

Cil~ Zip

V(lrl Telephone CrUuiltllillgcr Number

3 Relationship to child

City Zip

Home Tdephone Work Telephone CellulmlPager Number

4 _------~------_-------_-- ----shyRelationship to chillil~lInc

Add-e5s Zip

CellularPager Number

5 ---__shy ---Naill

----Relatlollship to child

City Zip


Page 4 of 13

1Surnbam oob ((barter ~d)ool MEDICAL INFORMATION FORVI

Please chtck all rhe following

Daily Medication Yes No Rheumatic Fever Yes No Drug A iicrgies Yes No Stizures Yes No

AIergyHayf~vtr Yes No Tuberculosis Yes No ~oAsthma Yes No Speech Defect Yes

Chicken Pox Yes 1lt0 Ear Defect Yes No Yes NoDiabetes Yes No Eye Def~~ct

Heart Trouble Yes No Food Allergies Yes No

(if yes ~lcase list foods) --~-----

I-Other ilealh information

Burnham Wood Chalter School coes not disp~nse any medication without prior written permission from the parentguardian The parentguatdian must provide the Iredlcatioll in propaly labeled containers and complete a

medication form (available at oUt offke)

However should the school personnel reel it is necessary to administel over the counter medications does the school have authorization to administer

oNo (This may be a brand name or a generic) Acetaminophen (Tylenol) DYes

oNo (This may be a brand name or a generic) Throat Lozenges DYes

oNo (This may be a brand name or a generic)Cough Drops DYes

MylanraiPepto- R IsmoliTums DYes UNo (This may be a brand name or a generic)

Topicltil gelcremespray DYes ONo (This may be a brand name or a generic)

for itchingsunburnscrapes

Liquid Tears to wash DYes o No (This may ~e a brand name or a generic)

out eyes

Family Doctor _____ __ ~__ ___________~____ Telephone

1 give permission for the school ~o call an ambulallce in an emergency Please illdicate hospital prefeten~e ________ _________

~~_Health Insurance Company ~_____ ___________ Telephone Number ______

Policy Number __~_~_ ____ _Group ~lIl11ber _ ________

ParentGuardian Sigt)ature Date Page 5 of 13

3

1Surnbam mloob ([barter $cbool

First Name

MEDIA RELEASE FORM

I hereb~ give J1l permission to Burnham Wood Charter School to use or release the name and photograph(s) of ~____ _____________ _____~~(childs name) in any manner Burnham Vood Charter School sraff

declTls (lpproprilre for publicity pJrposes

IlInd(r~land thc~c purposes include publication ofpilologrJphs along with my 11JIlle andor that l)fmy child in neiSpapCrs llla~azincs_ brochures and other uch publicJlil)JlS for television appearances t~)r slide rresentarions and other

visual lrlZ1trriai and for radio bmadcast shmvs

[ also understand that I am free to refuse this permission but that my child cannot appcar 011 public radio broadcasts or television or h~l( hisher name apptar in printed tllDtter rleased hy Burnham Alood Charter School Vlthout signing this releaSe

ParcllLGuardian Signawre Date

FJELD TRIP RELEASE FORM

I hertb)- give my permission for my child to attend school-sponsored activities off campus and be transported by the school

ParenlXillardian Signature Date

PLEDGE AID STUDENT CONDUCT

The following are agreements I have made with my teachers concerning my attitude and behavior while pru1icipating in

Burnhatn Wood Charler School programs

STUDENT CO] DUCT I I vill abide by all regular school ruks as well as by directions given me by my teachers or staff to insure my safety

and the safety of others

1 I shall abidt= by codes of dress which are appropriate for the activities in which I participate No clothing shall be worn which might be offensive or obscene

I vjll be prompt and on time to all activities I agree that lHy behavior should reflect my respect for thlt environment and indicate my desire to lei1rn more aboLlt Ollr responsibility to maintain it

4 I fully undtrstand that I WILL be sent home if any behavior or action on my part poses a threat to my own safety the ~afety ofotbers disrupts the instructional program or results in the destruction of the environment in any wy

I AGREE TO THE TERMS STATED ABOVE WHICH HAVE BEEN EXPLAIIED TO ME BY MY PARENTCCARDIAN

Students Signature Date

Par~ntGuardian Signature Date

Page 6 of 13

jLlurnbam mtoobCbartcr $cbool _ -_ -_------- -__-shy

First Name LJst N-111~

STGDENT ATTENDA(CE AGREEMENT

I understand til1 Burnham Wood Chan~r School requires 180 days of attendance Ifmy student is absent I ilgree to bring

my student to the next scheduled make-up day offered by the school

J understand tl1m the ~chedllled maKe-lip day may be after school on a Saturdagt _ or a vac~ltion day

DatePar~tlt(jLlardiall Signature

PARENT PARTICIPATION AGREEMENT

BU1Ilham Wood Charter Schooll~quests our parents to provide five- (5) hours per family per semester for a total of (11 (10) hours pel school year of on-sih work hours (co-op hours)

I am inillcsted ill the following aleas (Pl~ltl~ check dc-siled choicts)

I FacultyStall Assistance

) Fundraising

__3 Facilities Vlaintenance

_~_4 COlllmunity Service Learning

5 Library Supp0l1- Please list the dRYS and times you are available____

__6 Offict Support - Please lis tbe days and times yOll are available ______ ----------- shy

7 Comm ittee Service

8 Supervision (lunch aftcr scllooL etc)

9 Curriculuill Support (For example outside speakers performers tickets to childrens conCC11S workshops)

Special Talents (please circle one) Drama Music Art Dance Physical Development Other

Please lis1 any special areas of interst that you might share with the classroom (For example quilting history cooking crafts Texas history astronomy Eampyptology poetry wildlife computers reading dC)

-----__

-___ -_ -~--~- _ ---- --~-~---------~~-

-_- --_ ----_--_ ---____--- - ------ shy

--__ _-----_ ___----------- shyDateParentGuardian Signature

Page 7 of 13

Jiurnbam oob (l[bartcr $cbool

FirsL ~alllt

DRESS CODE AGREEMENT

The vay Olil students dress is a direct rencctiOll upon Burnham Vvood Wht11 pride is retlected in the way our students dress thi sanK pride will sho in the-ir conduct and academic achicvelllerH We thcrcfort request tbat all students COllle to gtchoo lltatly JIHl appropriately dres1cd

BOYS should ear

bull Slacks or shorts of solid COiN navy or khaki that fit properl) at [he waist and hips bull Button-down long or short sl~ce solid color shirts ilh 1 collar or J olid color poln-styk shirt (Alack is not

allowed bull RlazLrs puHOer or cardigaJ~ sweaters o~- a solid COIOI

GlRLS should wellr

bull Slacks walking shorts or skirts of sold color navy or khaki that fit properly at the waist and hips bull Buttoll-dOvn long or short sli~eve solid color shirts with a collar or a solid color polo-style shil1 (Black is not

aUowed bull Blazers pullover or cardigan s eaters of a solid color

NO sveatshirts t-shirts black shirts or cargo pockets belts with studs caps or hats NO excessive jewelry or facial

jewelry except earrings No markings on your body that are 110t completely c()vered at all times No excessive nail polish

particularly bluck No hair color or hairstyle) that provoke undue attcnticn

Pleas I discourage this

Dress for Jily scl1001 sponsored activity must be appropriate and in good ta~te for the occasion All clothing such as coats sweaters jackets etc should be labeled

Every student must have a green polo-style shrt with the Burnham Wood logo Order forms and catalogs are available in

the schoo I office

I agree and support the Dress Code I m monitor my childs clothing every morning before heshe leaves for school I understand) will need to purchase a Burnham Wood Charter School polo-style shirt from the schools

supplier

---=----__- ----------- shyParenti(iuardian Signature Date

iJG2Page 8 of 13

----- ------ -- --- ------------- ---------------

------------

11ilurnbam gool (barter $cbool

- --- ------ -~- - shy---- --------__------- ---- ----shyFirst Naille

PERSOlAL HISTORY

In ordlr 101 us to learn more abom your child please share observalioJls and cOlUments

Hov dJes gtour child accept routines amllill1its~ ________

HO oot-- ~ I)ur child handle trans tions ---------- -- __---- ---_ --- -- shy

------------- ---- -------- ------ ---__shy

How does your child handle frustrations ___________________________ _____________

--------- --- ----__------------- --__-- -------- shy----- -----------------__--

Hov dues our child interact with other chikren _________ ------------ _ ---- --__--shy

----- -----------_ ---------__shyHow du you discipline your chile at home _------- --------------- -------------_-- shy

What ar~ your childs interests or hobbies ______ -------------------__---__---- ------- shy

-----------_- ---------- shy-- ------------__--shy

H-lS your lhild ever been labeled talented and gifted 50t or special education or as having counseling needs (Attention deficit hyperactive learning disabled behaviorally disordered anxious depressed conduct disordered oppositional) No___ __ Yes (please explain)___ ____ -----------~---- --- ------------ shy

_------------- shy

Did your child skip a grade Explain _

~---------~---

Was your child held back a gradpound~ Explain ____ -----~----

What ar( your childs strong points) _________ ----shy

---------- ---~--------___----------- -------------- shy

)hat 11( your childs weak poils~ _________________ --- -------------------- shy

- - ----------- -------- --------------------------- shy

No For what reason --------------- shyHas yom child ever been 011 medlcation Yes

------- ------------ ___---_ ----------- ---------------- shy

Explain _________________________No-las your ell ild ever been in troubl~ ith the 1lt1 Yes -------_--- --~-----

--- --- - _-- --------_---------- shy

Page 9 of 13

CHARACTERISTICS Seldom Frequently Usually COMMENTS

Short attention span

Overactive I Easily distracted

1I1lpulsimiddot

Speech diflicuties

Visual difficultie~

Hearing difticulties

l)oesnl finish work

Poor quality vork

eeus onemiddotto-0I1e att~ntion IVery ttl~i1tivc

Short term memory problems -shy

Daydreams

Socially irnmature

Aggre-ilve anuor destructive Lies andor stetls

Completes assignments

Anxious andor nervous

Easily tjustrated

Tries hard

Eager to learn -

Feels good about self

Right-left confusion

Poor at copyingwriting

Letter reversals

Please evaluate your child on a scale of 1-5

FairCircle the number of choice Good l AV(lllgC Poor I Unable to assess

Ability to read 1 2 3 4 5 1------=------------------~~ --If----~+-~+I----c -L--shy

I I

Math skills I I 2 I 3 I I 5

S_tucodOC Y

--ha_b__iIS7--~~_----_-_~~___-_~-~-_~-_-_-_-_----l-I-~lll---+Il-~~-i- Ii -shy 44 1--=5 5

i~~titUJe toward school ___ __ ~ 1

Ability to get along witb peers ) ~ 4 1 5

fbITity to get along wlth teachel and other aurhollty tigUles I I h I 3 i Abilit 10 handle stress ------I--r-i----~c--+I--3-----Ie-Abillty-C-o-ab-deb-y-rhe--ule--s------ --shy I I j I 3 -jl

4

--4~-T

4

1

1 -shy

i S

5--1

5

~cipiltioll in spoitSorother non-acadelllic activities --[1- j 2 3 T4---r-s-- Geral-he-a-Ith---- I 2 3] 4 5-shyI i I i

Page 10 of 13 ) 40- J

1Jj)urnbam oob ltCbartcr ~cbool 7310 BlShop Flores EI Paso TX 79912

(915) 584-9499 Fax (915) 585-8814

CONFIDENTiAL INFORMAnON CONSENTREUASE

Dat ofBirtil

The above-referenced student has enrolled at Burnham Wood Charter School

I authorize the registrarprincipaladministrative staff at

FAX---c---------- shy ~~----SchoolOrgallizali~)nAgellcy alllt)

to release the following records regarding the above named student to

jBurnl)am Nloob flCbartrr ~cbool Attn Reg istrar

7310 Bishop Flores El Paso TX 79912 (915) 584-9499 Fax (915) 585-8814

Records Req uested

fVledica Information Discipline Records

Educational Assessment Attendance Records

Sociological Information ARD IEP

Psychological Evaluation All special program records (special education 504 bilingualESL LEP TalentedGifted etc) If these records are located at another site please

TranscriptReport Card it1dicm~ here the person address and fax where the request should be sent

Other

o 0 J have been tully informed and Ilnderstand tbe schools request for my consent as described above ils (1 This information will bt releasedrequested upon receipt of my witten consent

o D (understand that 111~ consent is vOllntar) and may be revoked at anytime Yes n

--_ -----------~--------------~--Parent(iLlardian Signlture

Page 11 of 13

G 5

JjJurnbam Boob (barter $cbool 73 lOB ishop Flores EI Paso TX 79912

(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE

-__--------shyFirst ~nmc

Pkast sign this rdcrence release and rdum it with the enrollment packet

This form will be completed and sent by the AJministration to reterencts or former schools listed all your enr)IJment p3cket

L th~ undersigned hereby authorize any individual former school teacher or counselor identified as a reference or school to answer all questions that may be SOUghl in connection with my childs enrollment application or concerning my childs work habits character or skills I am aware that the information provided will be llsed fl1 the purpose of evaluating Illy child as an applicant for enrollment and that the lllforll1ation provided is cont~dtntilttl and will nul be Jailable to me I will not hold the individual or sclloolliable for the inforl11ation submitted A cop of this authorization shall be valid as the original

~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----

1l3urnbam oob ([barter ~cbool 7310 Bishop Flores El Paso TX 79912

(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES

Pan~n1s l)r kindergartners and firsl graders without school experience should provklt- at least 011( reference from an unrelated adult who knows the d lid All othr applicants 11ll1S provide a minimum of three school references

TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________

SCHOOL ADVIINISTRATIONCOUNSELOR REFERENCES

Position middotSchool _______________

Address________________________Zip_____

Telephonc_____________________________

4 Name______________

PositioniSchoo ______________________

Addrcss ____________________________Zip______

Ttkphonc __ ----------------------- shy

PHYSICIAN-HEALTH CARE PROFESSIONAL

5 Pbsician Name --------------------- shy

Address ____________________________Zip___

Telephone_______________________________

For Oftice Use Only Date StltDlle -11

--__ --------~------

Date Received ___ __ _

FoJ Oftice Use Only Date Sent Date Sent _____ _

COllllllent ________________

Date Received ____

For Office Use Only Date Sent _______ Date Sent ____

Comment _____________

Date Received ____

For Office Use Only Date Sent Date Sent _____

Comment _________________

Date Received

For Office Use Only Date S~nt _____ Date Sent _______

Comment ________________

Date Received _____

Page 13 of 13

r 7 J )

Attachment 5 Electronic Application Certification

- 8 u

Part 3 Electronic Copy Certification and Written Resolution (Attachment

Section XI Electronic Copy of Application

Please submit an electronic copy of the renewal application in addition to the five hard copies requested The copy should be on a 35 inch diskette and should be mailed along with the hard copies The electronic copy IITI______

identical to the hard copies The signatures below are required to certify that the electronic and hard copies armiddot----shyBy signing below I hereby certify that the enclosed electronic and hard copies are identical

Printed Name of Chairperson of Charter Holder Board Signature Date

~- 3 Printed Name of Chief Executive Officer of the CharterSc Date

Section XII Written Resolution

Applications must be accompanied by a written resolution adopted by the governing body of the charter hOldeby the members voting in favor The resolution must authorize the commissioner to renew the open-enrollmel set forth in the renewal application as finally negotiated between the charter holder and the commissioner inc conditions (Attachment 6 Written Resolution)

iJU 9

Attachment 6 Written Resolution

Adopted by Governing Body of Charter Holder

Imiddot J i U


Resolution May 31 2002

The EI Paso Education Initiative Inc (EPEI) authorizes the commissioner to renew the Burnham Wood Charter School an open-enrollment charter as set forth in this renewal application and as finally negotiated between EPEI and the commissioner including any conditions

The flIowing Board Members vote in favor of this resolution lt --7

~-- )SU-h~ Board Mem Board Member -~ ~- crv~-~A ~ d Board Member Board Member

Board Member Board Member

i) i 1




Tlitollo r~oard Members vote in favor of this resolution

J ~~ ~)Kl~---Board Member Board Member

~ A CI k~p a



~2IJ I

Application Instructions

The Renewal Application is due to TEACharter Schools Division by 5 00 pm June 14 2002 Applications will be date stamped as they are received and the date received will be documented Timely submission ofa complete renewal application may be used as part of the basis for renewal determination

The application form has been designed to be downloaded and responses can be entered directly onto the electronic application form on your computer The spaces provided for answering questions are expandable Use as much space as needed for responses

Attachments should be labeled as indicated in the application and submitted in prescribed order The forms for Attachment 3 Board Member Biographical Affidavit and Attachment 5 Electronic Application Certification are included with the application

Seven complete paper copies of the entire document must be submitted in prescribed order with only original signatures in blue ink One copy (less attachments) must also be submitted on a 35 inch floppy diskette (The agency uses a PC compatible text file)

Format ofApplication

Number of paper copies 7 Font 12 pt Times New Roman Paper 85xl 10 white one side only Binding NONE DO NOT BIND

May be rubber-banded or clipped

List ofAttachments

Attachment I Organizational Chart Attachment 2 Criminal History Records for Board Members Attachment 3 Board Member Biographical Affidavits Attachment 4 Special NeedsPrograms Information Request Attachment 5 Electronic Application Certification Attachment 6 Written Resolution Adopted by Goveruing Body of Charter Holder

2

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7






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FAMILY INFORMATION



of 13




------











~_-~__~~~~-_-_---=-=------=-----~~~-~_+_~~-----~~~-- ------------~-_i

I I l L _____Ll d ___________~










Page 3 of 13

Jr- shy

----------

--------------


I-irs Naille



City Zip



Cil~ Zip



City Zip



Add-e5s Zip


5 ---__shy ---Naill


City Zip


Page 4 of 13



















out eyes






3


First Name

MEDIA RELEASE FORM





















Page 6 of 13












) Fundraising










-----__

-___ -_ -~--~- _ ---- --~-~---------~~-

-_- --_ ----_--_ ---____--- - ------ shy


Page 7 of 13


FirsL ~alllt



BOYS should ear



GlRLS should wellr









the schoo I office


supplier


iJG2Page 8 of 13

----- ------ -- --- ------------- ---------------

------------



PERSOlAL HISTORY




------------- ---- -------- ------ ---__shy


--------- --- ----__------------- --__-- -------- shy----- -----------------__--




-----------_- ---------- shy-- ------------__--shy


_------------- shy


~---------~---



---------- ---~--------___----------- -------------- shy


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RElERENCE RELEASE





~~--~-------------------


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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

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(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

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(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

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School - --- --------- - - ------- ---------- shy

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the schoo I office


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----- ------ -- --- ------------- ---------------

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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

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Daydreams

Socially irnmature




Easily tjustrated

Tries hard

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Dat ofBirtil







Records Req uested






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Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

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____ZIp______

Telephone_______________________________



Address________________________Zip_____

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4 Name______________

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Addrcss ____________________________Zip______

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Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

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Comment _____________

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Page 13 of 13

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----- ------ -- --- ------------- ---------------

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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


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Daydreams

Socially irnmature




Easily tjustrated

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Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

Telephonc_____________________________

4 Name______________

PositioniSchoo ______________________

Addrcss ____________________________Zip______

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Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



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Date Received ____


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Page 13 of 13

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ow world today

---------~--------



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MOTHERS INFORMATION




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MOTHERGUARDIAN







FATHERGUARDIAN


- shy ---------~--c-~__-~





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Page 2 of 13




------











~_-~__~~~~-_-_---=-=------=-----~~~-~_+_~~-----~~~-- ------------~-_i

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Page 3 of 13

Jr- shy

----------

--------------


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City Zip



Cil~ Zip



City Zip



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Page 4 of 13



















out eyes






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MEDIA RELEASE FORM





















of 13












) Fundraising










-----__

-___ -_ -~--~- _ ---- --~-~---------~~-

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Page 7 of 13


FirsL ~alllt



BOYS should ear



GlRLS should wellr









the schoo I office


supplier


iJG2Page 8 of 13

----- ------ -- --- ------------- ---------------

------------



PERSOlAL HISTORY




------------- ---- -------- ------ ---__shy


--------- --- ----__------------- --__-- -------- shy----- -----------------__--




-----------_- ---------- shy-- ------------__--shy


_------------- shy


~---------~---



---------- ---~--------___----------- -------------- shy


- - ----------- -------- --------------------------- shy


------- ------------ ___---_ ----------- ---------------- shy


--- --- - _-- --------_---------- shy

Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





4

--4~-T

4

1

1 -shy

i S

5--1

5


Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

Telephonc_____________________________

4 Name______________

PositioniSchoo ______________________

Addrcss ____________________________Zip______

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Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

Date Received ____


Comment _____________

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Comment _________________

Date Received


Comment ________________

Date Received _____

Page 13 of 13

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PosmON COMPENSATION















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(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

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(915) 584-9499 Fax (915) 585-8814

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REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

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Address________________________Zip_____

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Page 6 of 13












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----- ------ -- --- ------------- ---------------

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1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


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Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

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Address________________________Zip_____

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ow world today

---------~--------



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MOTHERS INFORMATION




Name of Employer







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~=-~~ ~-~-~~~ ~-~~c~--~~~~















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STUDENT INFORMATION









MOTHERGUARDIAN







FATHERGUARDIAN


- shy ---------~--c-~__-~





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Page 2 of 13




------











~_-~__~~~~-_-_---=-=------=-----~~~-~_+_~~-----~~~-- ------------~-_i

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Page 3 of 13

Jr- shy

----------

--------------


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City Zip



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Page 4 of 13



















out eyes






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Page 6 of 13












) Fundraising










-----__

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Page 7 of 13


FirsL ~alllt



BOYS should ear



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the schoo I office


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----- ------ -- --- ------------- ---------------

------------



PERSOlAL HISTORY




------------- ---- -------- ------ ---__shy


--------- --- ----__------------- --__-- -------- shy----- -----------------__--




-----------_- ---------- shy-- ------------__--shy


_------------- shy


~---------~---



---------- ---~--------___----------- -------------- shy


- - ----------- -------- --------------------------- shy


------- ------------ ___---_ ----------- ---------------- shy


--- --- - _-- --------_---------- shy

Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





4

--4~-T

4

1

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Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

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Telephone_______________________________


--__ --------~------



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Date Received ____


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Date Received _____

Page 13 of 13

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Page 6 of 13












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1I1lpulsimiddot

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Records Req uested






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(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

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------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

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Address________________________Zip_____

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1I1lpulsimiddot

Speech diflicuties

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Records Req uested






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Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

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REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

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2 Telchtr Name----------------------- shy

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--__ --------~------



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Page 13 of 13

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planned








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---------~--------



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MOTHERS INFORMATION




Name of Employer







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MOTHERGUARDIAN







FATHERGUARDIAN


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~_-~__~~~~-_-_---=-=------=-----~~~-~_+_~~-----~~~-- ------------~-_i

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Page 3 of 13

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Page 6 of 13












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Page 7 of 13


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------- ------------ ___---_ ----------- ---------------- shy


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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

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Tries hard

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(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

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Telephone_______________________________


--__ --------~------



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Date Received ____


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Date Received ____


Comment _________________

Date Received


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(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





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1I1lpulsimiddot

Speech diflicuties

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Page 11 of 13

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(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

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Address________________________Zip_____

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FATHERGUARDIAN


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Page 2 of 13




------











~_-~__~~~~-_-_---=-=------=-----~~~-~_+_~~-----~~~-- ------------~-_i

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Jr- shy

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out eyes






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Page 6 of 13












) Fundraising










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----- ------ -- --- ------------- ---------------

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------------- ---- -------- ------ ---__shy


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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

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(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

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Address________________________Zip_____

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planned








ow world today

---------~--------



Address

MOTHERS INFORMATION




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MOTHERGUARDIAN







FATHERGUARDIAN


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Page 2 of 13




------











~_-~__~~~~-_-_---=-=------=-----~~~-~_+_~~-----~~~-- ------------~-_i

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Page 3 of 13

Jr- shy

----------

--------------


I-irs Naille



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Cil~ Zip



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Add-e5s Zip


5 ---__shy ---Naill


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Page 4 of 13



















out eyes






3


First Name

MEDIA RELEASE FORM





















Page 6 of 13












) Fundraising










-----__

-___ -_ -~--~- _ ---- --~-~---------~~-

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Page 7 of 13


FirsL ~alllt



BOYS should ear



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----- ------ -- --- ------------- ---------------

------------



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------------- ---- -------- ------ ---__shy


--------- --- ----__------------- --__-- -------- shy----- -----------------__--




-----------_- ---------- shy-- ------------__--shy


_------------- shy


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- - ----------- -------- --------------------------- shy


------- ------------ ___---_ ----------- ---------------- shy


--- --- - _-- --------_---------- shy

Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





4

--4~-T

4

1

1 -shy

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Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

Telephonc_____________________________

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Telephone_______________________________


--__ --------~------



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Date Received ____


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(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


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1I1lpulsimiddot

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Dat ofBirtil







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Page 11 of 13

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(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

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(915) 584-9499 Fax (915) 585-8814

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First -JltlnlC

REFERENCES


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I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

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Page 6 of 13












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----- ------ -- --- ------------- ---------------

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1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


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Socially irnmature




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(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

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Page 4 of 13



















out eyes






3


First Name

MEDIA RELEASE FORM





















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Page 7 of 13


FirsL ~alllt



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supplier


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----- ------ -- --- ------------- ---------------

------------



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------------- ---- -------- ------ ---__shy


--------- --- ----__------------- --__-- -------- shy----- -----------------__--




-----------_- ---------- shy-- ------------__--shy


_------------- shy


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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




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I I


S_tucodOC Y





4

--4~-T

4

1

1 -shy

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5--1

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Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

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Dat ofBirtil







Records Req uested






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Page 11 of 13

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RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

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Page 9 of 13




1I1lpulsimiddot

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Daydreams

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Easily tjustrated

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Dat ofBirtil







Records Req uested






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Page 11 of 13

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(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

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(915) 584-9499 Fax (915) 585-8814

--~-----------

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REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

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(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

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Page 3 of 13

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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


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Daydreams

Socially irnmature




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S_tucodOC Y





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(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

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MOTHERGUARDIAN







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Page 2 of 13




------











~_-~__~~~~-_-_---=-=------=-----~~~-~_+_~~-----~~~-- ------------~-_i

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Page 3 of 13

Jr- shy

----------

--------------


I-irs Naille



City Zip



Cil~ Zip



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Page 4 of 13



















out eyes






3


First Name

MEDIA RELEASE FORM





















Page 6 of 13












) Fundraising










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-___ -_ -~--~- _ ---- --~-~---------~~-

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Page 7 of 13


FirsL ~alllt



BOYS should ear



GlRLS should wellr









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----- ------ -- --- ------------- ---------------

------------



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- - ----------- -------- --------------------------- shy


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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





4

--4~-T

4

1

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Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

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Page 13 of 13

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Dat ofBirtil







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Page 11 of 13

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(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

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(915) 584-9499 Fax (915) 585-8814

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1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


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Daydreams

Socially irnmature




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Tries hard

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Dat ofBirtil







Records Req uested






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Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

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(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

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Page 6 of 13












) Fundraising










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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

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Daydreams

Socially irnmature




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Tries hard

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(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

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Address________________________Zip_____

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Jr- shy

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City Zip



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Page 4 of 13



















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Page 6 of 13












) Fundraising










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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

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S_tucodOC Y





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(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

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Address________________________Zip_____

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Page 13 of 13

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MOTHERGUARDIAN







FATHERGUARDIAN


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Page 2 of 13




------











~_-~__~~~~-_-_---=-=------=-----~~~-~_+_~~-----~~~-- ------------~-_i

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Page 3 of 13

Jr- shy

----------

--------------


I-irs Naille



City Zip



Cil~ Zip



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Add-e5s Zip


5 ---__shy ---Naill


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Page 4 of 13



















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First Name

MEDIA RELEASE FORM





















Page 6 of 13












) Fundraising










-----__

-___ -_ -~--~- _ ---- --~-~---------~~-

-_- --_ ----_--_ ---____--- - ------ shy


Page 7 of 13


FirsL ~alllt



BOYS should ear



GlRLS should wellr









the schoo I office


supplier


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----- ------ -- --- ------------- ---------------

------------



PERSOlAL HISTORY




------------- ---- -------- ------ ---__shy


--------- --- ----__------------- --__-- -------- shy----- -----------------__--




-----------_- ---------- shy-- ------------__--shy


_------------- shy


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- - ----------- -------- --------------------------- shy


------- ------------ ___---_ ----------- ---------------- shy


--- --- - _-- --------_---------- shy

Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





4

--4~-T

4

1

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5--1

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Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

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Address________________________Zip_____

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Telephone_______________________________


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Comment _____________

Date Received ____


Comment _________________

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Date Received _____

Page 13 of 13

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1I1lpulsimiddot

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Dat ofBirtil







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Page 11 of 13

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(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


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(915) 584-9499 Fax (915) 585-8814

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Page 13 of 13

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Page 6 of 13












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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

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Daydreams

Socially irnmature




Easily tjustrated

Tries hard

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(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

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------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

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Telephone_______________________________


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Date Received ____


Comment _____________

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Comment _________________

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Date Received _____

Page 13 of 13

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Page 6 of 13












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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




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I I


S_tucodOC Y





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(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

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Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



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Date Received ____


Comment _____________

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Comment _________________

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Date Received _____

Page 13 of 13

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FATHERGUARDIAN


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FAMILY INFORMATION



Page 2 of 13




------











~_-~__~~~~-_-_---=-=------=-----~~~-~_+_~~-----~~~-- ------------~-_i

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Page 3 of 13

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----------

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I-irs Naille



City Zip



Cil~ Zip



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Page 4 of 13



















out eyes






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First Name

MEDIA RELEASE FORM





















Page 6 of 13












) Fundraising










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-___ -_ -~--~- _ ---- --~-~---------~~-

-_- --_ ----_--_ ---____--- - ------ shy


Page 7 of 13


FirsL ~alllt



BOYS should ear



GlRLS should wellr









the schoo I office


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------------- ---- -------- ------ ---__shy


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------- ------------ ___---_ ----------- ---------------- shy


--- --- - _-- --------_---------- shy

Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





4

--4~-T

4

1

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(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

Telephonc_____________________________

4 Name______________

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Addrcss ____________________________Zip______

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Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



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Date Received ____


Comment _____________

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Comment _________________

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Date Received _____

Page 13 of 13

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Page 3 of 13

Jr- shy

----------

--------------


I-irs Naille



City Zip



Cil~ Zip



City Zip



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Page 4 of 13



















out eyes






3


First Name

MEDIA RELEASE FORM





















Page 6 of 13












) Fundraising










-----__

-___ -_ -~--~- _ ---- --~-~---------~~-

-_- --_ ----_--_ ---____--- - ------ shy


Page 7 of 13


FirsL ~alllt



BOYS should ear



GlRLS should wellr









the schoo I office


supplier


iJG2Page 8 of 13

----- ------ -- --- ------------- ---------------

------------



PERSOlAL HISTORY




------------- ---- -------- ------ ---__shy


--------- --- ----__------------- --__-- -------- shy----- -----------------__--




-----------_- ---------- shy-- ------------__--shy


_------------- shy


~---------~---



---------- ---~--------___----------- -------------- shy


- - ----------- -------- --------------------------- shy


------- ------------ ___---_ ----------- ---------------- shy


--- --- - _-- --------_---------- shy

Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





4

--4~-T

4

1

1 -shy

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5--1

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Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

Telephonc_____________________________

4 Name______________

PositioniSchoo ______________________

Addrcss ____________________________Zip______

Ttkphonc __ ----------------------- shy



Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

Date Received ____


Comment _____________

Date Received ____


Comment _________________

Date Received


Comment ________________

Date Received _____

Page 13 of 13

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Page 3 of 13

Jr- shy

----------

--------------


I-irs Naille



City Zip



Cil~ Zip



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Page 4 of 13



















out eyes






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First Name

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Page 6 of 13












) Fundraising










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-___ -_ -~--~- _ ---- --~-~---------~~-

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Page 7 of 13


FirsL ~alllt



BOYS should ear



GlRLS should wellr









the schoo I office


supplier


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----- ------ -- --- ------------- ---------------

------------



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------------- ---- -------- ------ ---__shy


--------- --- ----__------------- --__-- -------- shy----- -----------------__--




-----------_- ---------- shy-- ------------__--shy


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- - ----------- -------- --------------------------- shy


------- ------------ ___---_ ----------- ---------------- shy


--- --- - _-- --------_---------- shy

Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





4

--4~-T

4

1

1 -shy

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Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

Telephonc_____________________________

4 Name______________

PositioniSchoo ______________________

Addrcss ____________________________Zip______

Ttkphonc __ ----------------------- shy



Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

Date Received ____


Comment _____________

Date Received ____


Comment _________________

Date Received


Comment ________________

Date Received _____

Page 13 of 13

r 7 J )


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Page 4 of 13



















out eyes






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First Name

MEDIA RELEASE FORM





















Page 6 of 13












) Fundraising










-----__

-___ -_ -~--~- _ ---- --~-~---------~~-

-_- --_ ----_--_ ---____--- - ------ shy


Page 7 of 13


FirsL ~alllt



BOYS should ear



GlRLS should wellr









the schoo I office


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iJG2Page 8 of 13

----- ------ -- --- ------------- ---------------

------------



PERSOlAL HISTORY




------------- ---- -------- ------ ---__shy


--------- --- ----__------------- --__-- -------- shy----- -----------------__--




-----------_- ---------- shy-- ------------__--shy


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------- ------------ ___---_ ----------- ---------------- shy


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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





4

--4~-T

4

1

1 -shy

i S

5--1

5


Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

Telephonc_____________________________

4 Name______________

PositioniSchoo ______________________

Addrcss ____________________________Zip______

Ttkphonc __ ----------------------- shy



Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

Date Received ____


Comment _____________

Date Received ____


Comment _________________

Date Received


Comment ________________

Date Received _____

Page 13 of 13

r 7 J )


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Imiddot J i U







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out eyes






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First Name

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Page 6 of 13












) Fundraising










-----__

-___ -_ -~--~- _ ---- --~-~---------~~-

-_- --_ ----_--_ ---____--- - ------ shy


Page 7 of 13


FirsL ~alllt



BOYS should ear



GlRLS should wellr









the schoo I office


supplier


iJG2Page 8 of 13

----- ------ -- --- ------------- ---------------

------------



PERSOlAL HISTORY




------------- ---- -------- ------ ---__shy


--------- --- ----__------------- --__-- -------- shy----- -----------------__--




-----------_- ---------- shy-- ------------__--shy


_------------- shy


~---------~---



---------- ---~--------___----------- -------------- shy


- - ----------- -------- --------------------------- shy


------- ------------ ___---_ ----------- ---------------- shy


--- --- - _-- --------_---------- shy

Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





4

--4~-T

4

1

1 -shy

i S

5--1

5


Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

Telephonc_____________________________

4 Name______________

PositioniSchoo ______________________

Addrcss ____________________________Zip______

Ttkphonc __ ----------------------- shy



Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

Date Received ____


Comment _____________

Date Received ____


Comment _________________

Date Received


Comment ________________

Date Received _____

Page 13 of 13

r 7 J )


- 8 u









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Imiddot J i U







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Page 6 of 13












) Fundraising










-----__

-___ -_ -~--~- _ ---- --~-~---------~~-

-_- --_ ----_--_ ---____--- - ------ shy


Page 7 of 13


FirsL ~alllt



BOYS should ear



GlRLS should wellr









the schoo I office


supplier


iJG2Page 8 of 13

----- ------ -- --- ------------- ---------------

------------



PERSOlAL HISTORY




------------- ---- -------- ------ ---__shy


--------- --- ----__------------- --__-- -------- shy----- -----------------__--




-----------_- ---------- shy-- ------------__--shy


_------------- shy


~---------~---



---------- ---~--------___----------- -------------- shy


- - ----------- -------- --------------------------- shy


------- ------------ ___---_ ----------- ---------------- shy


--- --- - _-- --------_---------- shy

Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





4

--4~-T

4

1

1 -shy

i S

5--1

5


Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

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Addrcss ____________________________Zip______

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Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

Date Received ____


Comment _____________

Date Received ____


Comment _________________

Date Received


Comment ________________

Date Received _____

Page 13 of 13

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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


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Daydreams

Socially irnmature




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Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

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(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

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(915) 584-9499 Fax (915) 585-8814

--~-----------

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REFERENCES


TEACHER REFEREliCES

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School - --- --------- - - ------- ---------- shy

________________Zip______Address

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Address________________________Zip_____

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Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

Date Received ____


Comment _____________

Date Received ____


Comment _________________

Date Received


Comment ________________

Date Received _____

Page 13 of 13

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----- ------ -- --- ------------- ---------------

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Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





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--4~-T

4

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1 -shy

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Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

Telephonc_____________________________

4 Name______________

PositioniSchoo ______________________

Addrcss ____________________________Zip______

Ttkphonc __ ----------------------- shy



Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

Date Received ____


Comment _____________

Date Received ____


Comment _________________

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Date Received _____

Page 13 of 13

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------- ------------ ___---_ ----------- ---------------- shy


--- --- - _-- --------_---------- shy

Page 9 of 13




1I1lpulsimiddot

Speech diflicuties

Visual difficultie~


l)oesnl finish work

Poor quality vork



Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





4

--4~-T

4

1

1 -shy

i S

5--1

5


Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

Telephonc_____________________________

4 Name______________

PositioniSchoo ______________________

Addrcss ____________________________Zip______

Ttkphonc __ ----------------------- shy



Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

Date Received ____


Comment _____________

Date Received ____


Comment _________________

Date Received


Comment ________________

Date Received _____

Page 13 of 13

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1I1lpulsimiddot

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Daydreams

Socially irnmature




Easily tjustrated

Tries hard

Eager to learn -




Letter reversals




I I


S_tucodOC Y





4

--4~-T

4

1

1 -shy

i S

5--1

5


Page 10 of 13 ) 40- J


(915) 584-9499 Fax (915) 585-8814


Dat ofBirtil







Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

Telephonc_____________________________

4 Name______________

PositioniSchoo ______________________

Addrcss ____________________________Zip______

Ttkphonc __ ----------------------- shy



Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

Date Received ____


Comment _____________

Date Received ____


Comment _________________

Date Received


Comment ________________

Date Received _____

Page 13 of 13

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Records Req uested






Other




Page 11 of 13

G 5


(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

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Telephone_______________________________



Address________________________Zip_____

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4 Name______________

PositioniSchoo ______________________

Addrcss ____________________________Zip______

Ttkphonc __ ----------------------- shy



Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

Date Received ____


Comment _____________

Date Received ____


Comment _________________

Date Received


Comment ________________

Date Received _____

Page 13 of 13

r 7 J )


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iJU 9



Imiddot J i U







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(915) 584-9499 Fax (915) 585-8814

RElERENCE RELEASE





~~--~-------------------


nJu ( Page 12 of l3

- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

Telephonc_____________________________

4 Name______________

PositioniSchoo ______________________

Addrcss ____________________________Zip______

Ttkphonc __ ----------------------- shy



Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

Date Received ____


Comment _____________

Date Received ____


Comment _________________

Date Received


Comment ________________

Date Received _____

Page 13 of 13

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- --------------------

--------------------------

------------------- -----


(915) 584-9499 Fax (915) 585-8814

--~-----------

First -JltlnlC

REFERENCES


TEACHER REFEREliCES

I TKi1er wne ------- ----_---- -- ----- shy---~------

School - --- --------- - - ------- ---------- shy

________________Zip______Address

Teephulle____

2 Telchtr Name----------------------- shy

School ---------------------------- shy

____ZIp______

Telephone_______________________________



Address________________________Zip_____

Telephonc_____________________________

4 Name______________

PositioniSchoo ______________________

Addrcss ____________________________Zip______

Ttkphonc __ ----------------------- shy



Address ____________________________Zip___

Telephone_______________________________


--__ --------~------



COllllllent ________________

Date Received ____


Comment _____________

Date Received ____


Comment _________________

Date Received


Comment ________________

Date Received _____

Page 13 of 13

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7:7 7{2C' ~; i)i4(C( [i/'ja-ci be) L) - Texas Education Agency

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Transcript of 7:7 7{2C' ~; i)i4(C( [i/'ja-ci be) L) - Texas Education Agency