E 6187dIntent To Renew Charter School Application

Application for Renewal of a Public School Charter
Kenai Peninsula Borough School District

Please complete all of the information required on this form. All intent forms for renewing a charter school must be received by August 1 of the renewal year. For further details see the following documents:

1. KPBSD Board Policy and Administrative Regulations on charter schools.
2. State of Alaska DEED charter school web site and renewal application.
3. Charter school guidelines and renewal procedures.

School Name: _______________________________________
School Address: _______________________________________
City, State, Zip Code: _______________________________________

School Contact Information:
Name: _______________________________________
Title: _______________________________________
Telephone: _______________________________________
Email Address: _______________________________________

Date of APC Approval of Renewal Application: ________________

Renewal Submission Date: ________________

By submitting this application, the undersigned affirms that the APC has reviewed and approved the request for charter renewal and that all necessary documentation will be provided in accordance with district and state requirements.

NOTE: Upon receipt of the application for renewal form the Kenai Peninsula Borough School District administration will arrange for a meeting during which the content of this renewal will be discussed.

_________________________________________  ___________

Charter School Authorized Representative Signature      Date

________________________________________  ___________

KPBSD Representative Signature                                  Date

Return this Application for Renewal to:

Superintendent of Schools

Kenai Peninsula Borough School District

148 N. Binkley Street

Soldotna, AK 99669