RULE NO: RULE TITLE
6A-1.039: Supplemental Educational Services in Title I Schools
Form SES 100 as incorporated by reference was amended as shown below:
I. APPLICATION INSTRUCTIONS AND REQUIREMENTS
A. Submission Deadline Requirements
The submission deadline for the 2009-2010 academic school year is 11:59 p.m. Eastern Standard Time (EST) on May 25, 2009. For subsequent academic school years, the submission deadline is 11:59 p.m. EST on the first Friday in March. Applications submitted by means other than those set forth in the Request for Applications (RFA), and applications received after the deadline for submission, regardless of the cause or nature of the delay, will not be accepted or considered for approval by the Department.
Submission Deadline Requirements
This application process is for Supplemental Educational Services providers to become approved for the 2008-2009 academic school year and is for services provided to students by October 15, 2008. By March 3, 2008, each applicant must:
● Submit the on-line application
● Mail or hand deliver hard-copy documentation of the following:
o Cover Page
o Checklist of Hard-Copy Documentation Requirements
o Financial Soundness Documentation
o Original signed and properly executed assurances on Attachment A: General Assurances and Attachment B: Internet Statement of Assurances
The Florida Department of Education must receive all parts of the application by the stated deadline in order to be considered for review and approval. Failure to submit all parts by the deadline will result in the denial of approval of the application. No additional material beyond that which is requested will be considered.
1. On-line Application Requirements
This application must be SUBMITTED on-line at http://www.fldoe.org/flbpso no later than 11:59 p.m. EST on May 25, 2009. For subsequent academic school years, the submission deadline is 11:59 p.m. EST on the first Friday in March. It is the responsibility of the applicant to ensure that the on-line application is submitted by the stated deadline.
On-line Application Requirements
This application process is for the 2008-2009 academic school year and is for services provided to students by October 15, 2008. This application must be submitted on-line at http://www.fldoe.org/flbpso no later than 5:00 p.m. Eastern Standard Time on March 3, 2008. Applications received after this deadline will not be accepted.
2. Hard-Copy Documentation Requirements Hard-copy Documentation Requirements
The financial soundness documentation and assurances must be RECEIVED by the Florida Department of Education (FLDOE) no later than 5:00 p.m. Eastern Standard Time on May 25, 2009. For subsequent academic school years, the submission deadline is 5:00 p.m. EST on the last Friday in March. Hard-copy documentation must be mailed or hand-delivered to the address listed below no later than 5:00 p.m. Eastern Standard Time on March 3, 2008. It is the responsibility of the sender to ensure that all hard-copy documentation is received by the stated deadline.
Hard-copy documentation should be mailed or hand-delivered to:
Florida Department of Education
Bureau of Student Assistance Public School Options
325 West Gaines Street, Suite 348 316
Tallahassee, FL 32399-0400
B. Technical Assistance Technical Assistance
Technical assistance regarding this RFA, review rubric, and the procedures for submitting a complete application will be posted on the FDOE website for SES at http://www.fldoe.org/flbpso.
C. Method of Review and Scoring Requirements Method of Review and Scoring Requirements
Each application is reviewed to ensure accurate completion of requested information and data, compliance with all provider eligibility requirements, and agreement with assurances set forth in the document. A minimum of three five reviewers will review the scored portion of the application narrative as follows: the highest and lowest scores will be dropped and the remaining three scores will be averaged. After averaging the remaining three scores, Ssuccessful applications require the following:
● 75% of the total possible points A score of at least 70 points out of 100 points
● A score of at least two points for each question
● Submission of sufficient documentation of financial soundness
● Submission of all properly executed assurance pages
D. Method of Announcement Method of Announcement
All applicants will be notified by mail whether the application is approved or denied not approved. Additionally, the list of the state-approved SES providers for the 2008-2009 school year will be posted on the FLDOE Web site website for SES at http://www.fldoe.org/flbpso. Information regarding approval or non-approval will not be provided via email or telephone.
Eligible Service Providers
The following entities are eligible to apply to provide SES in Florida:
● Individuals
● For-profit companies
● Non-profit organizations
● Community-based/faith-based organizations
● Institutions of higher education
● Local educational agency such as a Florida public school district, a university laboratory school, and Florida Virtual School, that is not identified as in need of improvement, corrective action, or restructuring
● Public schools not identified as in need of improvement, corrective action, or restructuring
● Charter schools that are not identified as in need of improvement, corrective action, or restructuring
● Private schools
● 21st Century Community Learning Centers that are not affiliated with school districts identified as in need of improvement, corrective action, or restructuring
● Public libraries
● Distance learning services including computer-based instruction
● In-home tutoring services
● Family literacy programs
● Child care centers serving school-age students
● Regional educational consortia
● School districts that are in need of improvement and have obtained a United States Department of Education (USDE) waiver to be providers of SES.
II. APPLICATION PROPOSAL
Please consider each of the responses carefully as these responses will become part of the terms of the contract signed with the school district. In addition, FLDOE will monitor each provider to ensure that the implementation of the program is consistent with the approved application.
A. Contact Information (* means fields required)
*Name of Agency Head______________________________
*Federal Employer Identification Number (FEIN) or Federal Tax ID Number________________
*Name of Contact Person_____________*Title___________
*Mailing Address__________________________________
*City_______ *State_______ *Zip Code_______ *Telephone Number________ Fax Number________
*E-mail Address__________ Organization Web site ________
*Contact Person for SES________________ *Title________
This person will be listed on the SES Approved Provider Directory
*Mailing Address__________________________________
*City_______ *State_______ *Zip Code_______ *Telephone Number________ Fax Number________
*E-mail Address__________ Organization Web site ________
Contact Information (All fields required) __________________________________________________________________
Name of Company or Agency: _________________________________________________________________________
Federal Employer Identification Number (FEIN) or Federal Tax Identification Number: ____________________________
Name of Contact Person: ____________________________
Title: ____________________________________________
Mailing Address: ___________________________________
City/State/Zip Code: ________________________________
Telephone Number: ________________________________
Fax Number: ______________________________________
E-mail Address: ____________________________________
Organization Website: ________________________________
B. Applicant Status
Please complete the following information.
Applying as a NEW provider Applying as a RENEWING provider
Applicants Submitting as Renewing Providers:
(1) For which year(s) Hhas the applicant been approved to for provideing SES in Florida? □ Yes □ No
School year(s)__________________________________
Under what business name(s)_______________________
Serving which school district(s) _____________________
If approved in Florida, identify the Florida SES Provider ID Number(s)__________________________
(2) Is the applicant an approved provider for SES in any other state? Yes No
If yes, identify the state(s)__________________________
Under what business name(s)__________________________________________________________________
(3) Has the applicant been removed as an approved provider in any state or district within a state, including
Florida? Yes No
If yes, company Name(s) Used: _____________________
If yes, identify the state(s)__________________________
If yes, provide the school year(s) date(s), district(s), and the reason(s) for removal _______________________
(4) Has the applicant ever served as a provider in Florida under any business name and had a contract with a
district terminated? Yes No
Identify the district(s) _____________________________
If so, provide the school year and the reason(s) for termination ____________________________________
For which year(s) has the applicant been approved for
providing SES in Florida? _________________________
Under what business name(s): ______________________
Serving which school district(s): ____________________
If approved in Florida, identify the Florida SES Provider ID: ________________________________________
Is the applicant an approved provider for SES in any other state? _____________________________________
Yes No
Identify the state(s): _____________________________
Has the applicant been removed as an approved provider in any state or district within a state, including Florida? _____________________________________________
Yes No
Identify the state(s): _____________________________
If yes, provide the state(s), school year(s) date(s), district(s), and the reason(s) for removal: _____________
Has the applicant ever served as a provider in Florida and had a contract with a district terminated? __________
Yes No
Identify the district(s): ____________________________
If so, provide the school year and the reason(s) for termination: ___________________________________
Service History
Has the applicant conducted surveys of parents whose children received SES tutoring in the prior school year?
Yes No
If yes, do these results show that at least 50% of parents of participating students are satisfied with the services?
Yes No
Has the applicant’s instructional program been subject to a state or self-administered evaluation?
Yes No
If yes, do these results demonstrate that the provider’s instructional program has improved student achievement?
Yes No
C. School District(s) to be Served: Select all school districts in which the applicant requests approval and agrees to provide SES. School District(s) to be Served (select all school districts in which the applicant requests approval and agrees to provide SES):
Indicate the school district(s) for which the applicant will provide services. A list of Title I schools, by district, with the identified School In Need of Improvement (SINI) status may be accessed at http://www.fldoe.org/bsa/title1/pdf/2007sinilist.pdf.
*Applicants that select to serve students at Florida School for Deaf and Blind must be able to provide transcription of materials into large print and Braille. In addition, tutors serving deaf students must be fluent in American Sign Language.
(List of Districts – no change)
D. Applicant Classification of Eligible SES Providers: Check the category that best describes the applicant’s organization. Applicant Classification of Eligible SES Providers (check the category that best describes the applicant’s organization)
Individual
For-profit company
Non-profit organization
Community based/faith-based organization
Institution of higher education
Local educational agency such as a Florida public school district, a university laboratory school, and Florida Virtual School, that is not identified as in need of improvement, corrective action, or restructuring
Public schools not identified as in need of improvement, corrective action, or restructuring
Charter school not identified as in need of improvement, corrective action, or restructuring
Private school
21st Century Community Learning Center that is not affiliated with a school district that is identified as in need of improvement, corrective action, or restructuring
Public library
Distance learning service including computer based instruction
In-home tutoring service
Family literacy program
Child care center serving school-age students
Regional educational consortium
School districts that are in need of improvement and have obtained a United States Department of Education (US EDDE) waiver to be providers of SES.
Other ______________ Other (Describe):
E. Academic and Instructional Information ACADEMIC AND INSTRUCTIONAL INFORMATION
1. Subject Area(s): Check all that apply. Subject Area(s) (check all that apply):
Reading/Language Arts
Mathematics
Science ________
2. Additional Staff Qualifications: Check all that apply. Additional Staff Qualifications (check all that apply):
**NOTE**: All tutorial staff must meet the minimum standards for Title I paraprofessionals, as follows:
● Title I paraprofessionals must have a secondary school diploma or its recognized equivalent; and
● Title I paraprofessionals must have at least one of the following:
Ø Completed two years of study at an institution of higher education (equivalent to 60 semester hours)
Ø Obtained an associate’s (or higher) degree
Ø Met a rigorous standard of quality and be able to demonstrate, through a formal local academic assessment, knowledge of and the ability to assist in instructing, reading, writing, and mathematics (or, as appropriate, reading readiness, writing readiness, and mathematics readiness).
Indicate tutorial staff qualifications below:
Meet the minimum standards as Title I paraprofessionals
Are qualified with a reading certification or endorsement
Current State of Florida certified teachers Are qualified as state certified or licensed teachers
Ability to communicate languages other than English
Spanish
Haitian Creole
Other (Identify) ___________
Have experience in teaching students with specificd disabilities
Please specify disabilities:
Have experience in teaching students who are English Language Learners (ELL)
Have the ability to speak languages other than English
Spanish
Haitian Creole
Other (Identify):
Have experience in teaching students with visual impairments
Have experience in teaching students with hearing impairments
3. Type of Instruction: Check all that apply. Type of Instruction (check all that apply):
Individual tutoring
In-home tutoring. A parent or guardian must be present during and throughout all tutoring sessions.
Distance learning instruction (on-line, internet-based, or computer-based instruction)
Small group instruction (not to exceed a group size of five students per tutor)
Large group instruction (not to exceed a group size of eight students per tutor)
4. Grade Levels to be Served: Check all grades level you will serve for each subject area (Note: The curriculum described in the application must be appropriate for the grade levels indicated):
Grade Levels to be Served (check all that apply):
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F. SES Provisions
1. Student Capacity Student Capacity
___ Indicate the minimum number of students that the applicant would serve at each site
___ Indicate the maximum number of students that the applicant would serve in each school district
Yes No Capacity to serve students with disabilities or plans developed under section 504 of the Rehabilitation Act
Yes No Capacity to serve students who are English language learners (ELL)
Capacity to serve students with visual impairments
Capacity to serve students with hearing impairments
2. Location of Services: Check all that apply. Location of Services (check all that apply)
School campus
Provider facility
Faith-based center (for example, church, temple, or mosque.)
Community-based center
Student’s home (on-line or computer-based)
Student’s home with tutor present
Child Care Center
Public site such as public library (describe): _______________________________________________________
Other (describe): _______________________________
Transportation
Will the applicant provide transportation if services are provided at a site other than the student’s school?
Yes, transportation will be provided for each student enrolled from the school to the SES site and back to the school or home. Describe transportation service to be provided:
No, transportation will not be provided to students.
G. Operations: Check all that apply. Operations (check all that apply)
1. Day(s) Services will be Provided:
Weekday (Monday – Friday)
Weekend (Saturday – Sunday)
Day(s) Services will be Provided:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Frequency of SES sessions for each student:
Every Day Once a Week Twice a Week Three Times a Week Other (Describe):
2. Length of each service session: Cumulative sessions may not exceed two hours per day or six hours per week. Length of each service session (Cumulative sessions may not exceed two hours per day or six hours per week.):
2 Hours
1 Hour
30 Minutes
Other (describe) __________________________________
Can the applicant provide a minimum of 20 hours of tutoring per student?
Yes, the applicant can provide a minimum of 20 hours per student.
No, the applicant cannot provide a minimum of 20 hours per student.
3. Times of Service Times of Service:
Before school
After school
Weekends
Summer (Identify dates, such as June 1 – August 4, 2009):
Other (Describe):
H. Cost of Service COST OF SERVICE
1. Rate for Provision of SES: Per Student, Per Hour, Per Type of Instruction Rate for Provision of SES: Per Student, Per Hour, Per Type of Instruction
Indicate the rate to serve SES for each student per hour and for each type of instruction offered and indicated in this application under Type of Instruction. For the 2007-2008 school year, the statewide average cost per pupil for SES is $1,120. More detailed information on the cost per pupil allocation for supplemental educational services may be found at http://www.fldoe.org/flbpso/xls/perpupil-allocation0708.xls.
**Note** The allowable range is between $5 and up to $70 80 per hour for each student, per hour, and per type of instruction. RATE PER STUDENT PER HOUR:
$_______ Small group instruction (group size two to five students per tutor not to exceed five students with one tutor)
$_______ Large group instruction (group size six to eight students per tutor not to exceed ten students with one tutor)
$_______ Distance learning including computer-based instruction
$_______ Individual tutoring
$_______ In-home tutoring
III. APPLICATION NARRATIVE: To ensure an anonymous review of the application, the company name should not be included in this section.
THE FOLLOWING ITEM WILL NOT BE SCORED (0 points):
Summarize the overall proposed program in a narrative including services provided, diagnostic/prescription process, curriculum, type of instruction, mode of instruction, and major elements of the program.
THE FOLLOWING ITEMS WILL BE SCORED (0-5 points per question):
A. The provider must have a demonstrated record of effectiveness in increasing the student academic achievement toward meeting the state achievement standards [NCLB, 20 U.S.C. Section 6316(e)(12)(B)(i)].
1. Provide the Describe specific student achievement data that o document evidence that the applicant’s company or organization had a positive impact on increasing student achievement toward meeting state achievement standards. Include quantitative data that documents student learning gains.
2. Provide results of state evaluations and parent satisfaction surveys that attest to the program’s effectiveness in raising student achievement, if any exist.
B. The provider must document that the instruction provided is high quality, based upon research, and designed to increase student academic achievement of eligible students and attain proficiency in meeting the state’s academic achievement standards [NCLB, 20 U.S.C. Section 6316(e)(12)(C)(ii)].
2.3. Identify the curriculum and key instructional strategies of the proposed program and quantitative research that documents its effectiveness in increasing student achievement.
3. Identify the key instructional strategies of the proposed program and the quantitative research that documents the effectiveness of the instructional strategies in increasing student achievement. Examples of instructional strategies may include scaffolding, graphic organizers, use of manipulative resources, effective question and answer techniques, use of prior knowledge, direct instruction, directed practice, and mastery learning. For more information on effective instructional strategies, see http://www.cpt.fsu.edu/ESE/ in/strmain.html.
4. Identify the major design elements of the proposed program and quantitative research that documents the effectiveness of the elements in increasing student achievement. Examples of major elements may include mode of instruction, time on task, or resource materials.
5. Identify the delivery model of the proposed program and the quantitative research that documents the effectiveness in increasing student achievement. Include academic research with specific evidence the delivery model has positive impact on increasing student achievement. Examples of delivery models include group size for instruction, direct instruction, distance learning, computer-based, individual tutoring, in-home tutoring. (NOTE: Homework assistance is not a form of SES.)
3.6. Describe how instruction will be focused, intensive, and tailored to meet the needs of individual students, including students with disabilities, students with 504 plans, and English language learners.
C. The provider must ensure that supplemental educational services are consistent with the instructional program of the local educational agency and the academic standards set forth by the state (Sunshine State Standards) [NCLB, 20 U.S.C. Sections 6316(e)(5)(B) and 6316(e)(12)(B)(ii)].
4.7. Describe the alignment of the process the applicant will use to ensure that the proposed curriculum with is correlated to the Sunshine State Standards for each grade level and content area you plan to serve. For information on Florida’s Sunshine State Standards, see http://www.fldoe. org/bii/curriculum/sss/.
5.8. Describe the process the applicant will use to ensure the proposed program aligns with the instructional program of the school district(s) in which the applicant intends to serve students. Cite at least one example of the correlation of the proposed program and describe its integration with at least one district that the applicant intends to serve.
6.9. Describe how the process to ensure that the applicant will coordinate supplemental educational services with the classroom instructional program of the students receiving the services. Describe the specific methods, tools, and processes that will be used to execute this coordination.
D. The provider must set measurable achievement goals for each student in consultation with each student’s parents and the school district and adhere to the timetable for improving the student’s achievement in the student learning plan. The provider must measure the student’s progress, and regularly inform the student’s parents and teachers regarding the progress of the student in improving academic achievement as outlined in the student learning plan [NCLB, 20 U.S.C. Sections 6316(e)(3)(A) and (B)].
7.10. Describe how diagnostic assessment data will be used to identify the student’s knowledge and skills gaps and set measurable goals for the student learning plan.
8.11. Identify the specific assessment to be administered if district student data are not available for developing the student learning plan. Describe the specific pre- and post-assessments that will be used and the alignment to the Sunshine State Standards.
11. Describe the process and timelines for the development of the student learning plan.
9.12. Describe the procedures and timelines to be used to evaluate, monitor, and report, at a minimum monthly, each student’s progress toward meeting the goals as stated on the student learning plan. Address how applicant ensures that the progress reports are understandable to parents and in parents’ native language, if feasible. Include frequency of progress reports to student’s parents, teachers, and appropriate school district staff.
13. Describe how student attendance and participation data will be collected, verified, and reported to the school district. Include strategies for improving attendance of students who are habitually absent.
14. Describe the process and timelines the applicant will use to ensure that services begin no later than October 15th of each school year. Include steps and timelines the applicant will implement from approval of the application to the provision of services to students.
E. The provider must have the capacity and resources, including financial soundness and compliance with applicable federal, state, and local health, safety, and civil rights laws and regulations, to provide supplemental services to students [NCLB, 20 U.S.C. Sections 6316(e)(12)(B)(iii) and (e)(5)(C)].
10.15. Describe the applicant’s infrastructure, including resources such as personnel, buildings, or equipment, and capacity to ensure services begin no later than October 15th of each school year. Include roles and responsibilities of staff within the organization.
16. Describe the process for recruiting, hiring, and initial training of staff.
11.17. Describe the initial training, professional development, and ongoing support provided to tutors to ensure that the proposed program is implemented with fidelity.
12.18. Describe procedures for supervising tutors to ensure the proposed program is implemented with fidelity and that all employees comply with ethical business practices pursuant to assurances found in the Request for Application, such as behavior at provider fairs, quality of tutoring services, and effectiveness of instruction.
13.19. Describe the process and procedures for monitoring the program to ensure the proposed program is implemented with fidelity, such as tutor/student ratio, supervision of students, approved instructional materials, students on task, or beginning services on time.
20. Describe procedures to be used to ensure that all staff providing direct services to students or having access to school grounds comply with fingerprint-based background screening pursuant to Section 1012.465, Florida Statutes (Background screening requirements for certain noninstructional school district employees and contractors). For more information, see the related Technical Assistance Paper at http://www.fldoe.org/flbpso/pdf/tap_fingerprint.pdf.
IV. FINANCIAL SOUNDNESS – No change.
A. through F. No change.
G. Evidence of financial soundness:
If an applicant has been in business for two or more consecutive years submit:
Financial statements in the form of an income statement for the past two years
or
Financial audits signed by a certified public accountant for the past two years
If the applicant has been in business for less than two consecutive years submit:
Federal income tax returns of a member of the board of directors, a managing member, or chief officer for the past two years
AND
Documentation from a financial institution showing three months of operating expenses in the form of a line of credit, loan, or a pre-approved loan on behalf of the company
AND
List and submit on attached Three Months Projected Expense Report projected expenses to operate SES in Florida for three months. Expenses should include, but not be limited to, information on the resources to cover the costs of salaries, fingerprinting/background screening, insurance policies, instructional materials, marketing, professional development, and facility rental fees. The total projected expenses on the report should match, at a minimum, the amount of the line of credit, loan, or pre-approved loan secured from a financial institution
Cover Page
Financial Soundness
Copy of general liability insurance with the Department of Education listed as the certificate holder
Copy of evidence of fiscal soundness:
Annual financial statements or fiscal audits
or
Federal income tax returns and financial letter of credit
Evidence of legal qualification to do business in Florida
Verification of business or non-profit status
Signed notarized statements on agency letterhead regarding the organization’s (each required):
Suspension or disbarment from receiving federal funding
Any lawsuits filed against organization
Denial of approval or removed from approval status from another state
Unresolved complaints with the Better Business Bureau
List of the Board of Directors or chief officers of the organization, and their titles
Assurances with original signature
Attachment A
Attachment B
FINANCIAL SOUNDNESS
To prove financial soundness, applicants must mail or hand deliver a copy of the following documents to the Bureau of Public School Options at FDOE.
Note: Public schools and school districts need only submit supporting documentation for 1, 5, and 6.
1. Evidence of applicant’s current commercial general liability insurance in the form of a certificate of insurance with the Department of Education, Bureau of Public School Options listed as the certificate holder. The name of the applicant must match the name on the certificate.
2. Evidence of the applicant’s fiscal soundness. Submit:
● annual financial statements or fiscal audits signed by a certified public accountant for the past two years, or
● federal income tax returns for the past two years along with a letter of credit from a financial institution.
3. A copy of the most recent registration with the Florida Department of State (www.sunbiz.org), showing evidence that the applicant is legally qualified to do business in Florida.
4. Verification of business status or non-profit status. For example, an Internal Revenue Service (IRS) letter with FEIN or certificate issued by government.
5. Signed notarized statements on applicant’s letterhead by the individual authorized to act on behalf of the organization attesting to the following:
● The organization has not been suspended or disbarred from receiving federal funding. If yes, explain the circumstances for suspension or disbarment.
● The organization has had no lawsuits filed against them for educational or fiscal mismanagement, civil rights violations, criminal acts, or other reasons. If yes, provide information and the outcome for each instance.
● The organization has not been denied approval nor has its approval status as an SES provider been revoked. If the organization has been denied approval or its approval status as an SES provider has been revoked, identify such state(s) or district(s) and the reason(s) for such denial or revocation.
● The organization does not have any unresolved complaints with the Better Business Bureau or FDOE. If the organization does have any known unresolved complaints, provide an explanation of the complaint(s) and results.
6. A complete list of the board of directors and chief officers of the organization and their titles.
Three Months Projected Expense Report – No change.
V. ATTACHMENT A: GENERAL ASSURANCES
Execution Requirements
The assurance pages must contain no revisions, additions, or deletions, and must bear an original signature of the agency head in blue ink to distinguish it from a copy or facsimile. The printed name and original signature must match.
Assurances signed by officials other than the head of the providing agency must have a letter signed by the agency head, or documentation citing action of the governing body delegating authority to the person to sign on behalf of said official.
As the duly authorized representative of this applicant, I certify agreement and compliance with all of the following assurances and conditions: (No Change items 1-23)
I, THE UNDERSIGNED, CERTIFY that I am an individual authorized to act on behalf of the organization in submitting this application and assurances and that all of the information provided herein is true and accurate, to the best of my knowledge. I understand that, if any of the information contained herein has been misrepresented, that may constitute grounds for denying the applicant’s request for approval to be placed on the list of approved supplemental educational services providers or for removal from that same list. I further certify that the organization will comply with all of the assurances set forth herein. Failure to comply with the assurances during the school year may result in removal from the state-approved list and potential ineligibility to re-apply during the following two-year period.
_______________________ _________________________
Signature of Applicant Date signed
_______________________ _________________________
Printed Name Name of Agency/
Company/Group
_______________________
Title of Signing Agent
Note:
1. Printed name and original signature must match.
2. Use blue ink color for original signature.
3. “By”, “for,” or initials will not be accepted.
4. Rubber stamp signatures will not be accepted.
24. Applicant assures that it has not been removed and permanently barred from providing supplemental educational services in any state or district.
25. Applicants who selected to serve students at Florida School for Deaf and Blind and indicated a capacity to serve students with visual impairments assures that it will provide transcription of materials into large print and Braille.
26. Applicants who selected to serve students at Florida School for Deaf and Blind and indicated a capacity to serve students with hearing impairments assures that it will provide tutors fluent in American Sign Language.
27. Applicant assures that all tutorial staff meet the minimum standards for Title I paraprofessionals, as follows:
● Title I paraprofessionals must have a secondary school diploma or its recognized equivalent; and
● Title I paraprofessionals must have at least one of the following:
● Completed two years of study at an institution of higher education (equivalent to 60 semester hours)
● Obtained an associate’s (or higher) degree
● Met a rigorous standard of quality and be able to demonstrate, through a formal local academic assessment, knowledge of and the ability to assist in instructing, reading, writing, and mathematics (or, as appropriate, reading readiness, writing readiness, and mathematics readiness).
28. Applicant assures that cumulative sessions shall not exceed two hours per day or six hours per week.
29. Applicant understands that the allowable range is between $5 and up to $70 per hour for each student, and per type of instruction.
ATTACHMENT B: INTERNET STATEMENT OF ASSURANCES
Execution Requirements
The assurance pages must contain no revisions, additions, or deletions, and must bear an original signature of the agency head in blue ink to distinguish it from a copy or facsimile. The printed name and original signature must match.
Assurances signed by officials other than the head of the providing agency must have a letter signed by the agency head, or documentation citing action of the governing body delegating authority to the person to sign on behalf of said official.
The following guidelines define appropriate use of the Internet.
30. Applicant understands that tTransmitting any material in violation of any U.S. or state regulation or school board policy is prohibited. This includes, but is not limited to, copyrighted material and threatening or obscene material.
31. Applicant understands that aAll content transmitted via e-mail or the Internet shall be secular, neutral, and non-ideological.
32. Applicants providing on-line instruction agree to ensure the safety of all students while accessing the internet. It is the responsibility of the applicant to block all unsafe web content.
33. Applicant understands that hHate mail, harassment, discriminatory remarks, and other antisocial behaviors are unacceptable in Internet and other network communication.
34. Applicant understands that aAll information accessible via the Internet should be assumed to be private property and subject to copyright protection. Internet sources should be credited appropriately, as with the use of any copyrighted material.
35. Applicant has a responsibility to respect the privacy and property of students. Applicant should not intentionally seek information about, obtain copies of, or modify, files, data, or passwords of other users.
36. For the safety of students, applicant must not request or provide any personal information, such as addresses, phone numbers, or photographs.
37. Applicant should not expect that files are private. State and school district representatives, including school administrators, as well as parents, may review files and communications at any time to ensure that the network is being used responsibly. Applicant must gain written parental permission before communicating with students under the age of 13 via e-mail or the Internet.
38. Applicant has a responsibility to protect the student users from marketing and Spam.
39. Applicants shall ensure that the primary purpose of a computer in the SES program is instructional all computer equipment provided to. When a computer provided by the applicant is used for instructional purposes, the student is allowed to keep the computer is returned to the applicant upon completion of SES. If students will be using a school computer to access information from an applicant, the applicant must abide by all school and school district policies and procedures regarding computer/Internet use.
40. Applicant agrees to comply with all assurances set forth in this application.
I, THE UNDERSIGNED, CERTIFY that I am an individual authorized to act on behalf of the organization in submitting this application and assurances and that all of the information provided herein is true and accurate, to the best of my knowledge. All tutors/instructors employed by this organization will be notified of all guidelines regarding appropriate use of the Internet and that as a condition of employment with the provider, all employees who will provide SES shall agree to comply with the guidelines. I understand that, if any of the information contained herein has been misrepresented, that may constitute grounds for denying the applicant’s request for approval to be placed on the list of approved supplemental educational services providers or for removal from that same list. I further certify that the organization will comply with all of the assurances set forth herein. Failure to comply with the assurances during the school year may result in removal from the state-approved list and potential ineligibility to re-apply during the following two-year period.
I, the undersigned, agree that all tutors/instructors employed by this organization will be notified of all guidelines regarding appropriate use of the Internet and that as a condition of employment with the provider, all employees who will provide SES shall agree to comply with the guidelines. Failure to comply with the assurances during the school year may result in removal from the state-approved list and potential ineligibility to re-apply during the following two-year period.
_______________________ _______________________
Signature of Applicant Date signed
_______________________ _______________________
Printed Name Name of Agency/
Company/Group
_________________________
Title of Signing Agent
Note:
1. Printed name and original signature must match.
2. Use blue ink for original signature.
3. “By”, “for,” or initials will not be accepted.
4. Rubber stamp signatures will not be accepted.
Yes No
If yes, company Name(s) Used: ___________________________________________________________
If yes, identify the state(s)_____________________
If yes, provide the school year(s) date(s), district(s), and the reason(s) for removal ___________________
(4) Has the applicant ever served as a provider in Florida under any business name and had a contract with a district terminated? Yes No
Identify the district(s) __________________________
If so, provide the school year and the reason(s) for termination __________________________________
For which year(s) has the applicant been approved for providing SES in Florida?___________________________
Under what business name(s):________________________
Serving which school district(s):______________________
If approved in Florida, identify the Florida SES Provider ID:
Is the applicant an approved provider for SES in any other state?
Yes No
Identify the state(s):
Has the applicant been removed as an approved provider in any state or district within a state, including Florida?
Yes No
Identify the state(s):
If yes, provide the state(s), school year(s) date(s), district(s), and the reason(s) for removal:
Has the applicant ever served as a provider in Florida and had a contract with a district terminated?
Yes No
Identify the district(s):
If so, provide the school year and the reason(s) for termination:
Service History
Has the applicant conducted surveys of parents whose children received SES tutoring in the prior school year?
Yes No
If yes, do these results show that at least 50% of parents of participating students are satisfied with the services?
Yes No
Has the applicant’s instructional program been subject to a state or self-administered evaluation?
Yes No
If yes, do these results demonstrate that the provider’s instructional program has improved student achievement?
Yes No
C. School District(s) to be Served: Select all school districts in which the applicant requests approval and agrees to provide SES. School District(s) to be Served (select all school districts in which the applicant requests approval and agrees to provide SES):
Indicate the school district(s) for which the applicant will provide services. A list of Title I schools, by district, with the identified School In Need of Improvement (SINI) status may be accessed at http://www.fldoe.org/bsa/title1/pdf/2007sinilist.pdf.
*Applicants that select to serve students at Florida School for Deaf and Blind must be able to provide transcription of materials into large print and Braille. In addition, tutors serving deaf students must be fluent in American Sign Language.
(List of Districts – No change)
D. Applicant Classification of Eligible SES Providers: Check the category that best describes the applicant’s organization. Applicant Classification of Eligible SES Providers (check the category that best describes the applicant’s organization).
Individual
For-profit company
Non-profit organization
Community based/faith-based organization
Institution of higher education
Local educational agency such as a Florida public school district, a university laboratory school, and Florida Virtual School, that is not identified as in need of improvement, corrective action, or restructuring
Public schools not identified as in need of improvement, corrective action, or restructuring
Charter school not identified as in need of improvement, corrective action, or restructuring
Private school
21st Century Community Learning Center that is not affiliated with a school district that is identified as in need of improvement, corrective action, or restructuring
Public library
Distance learning service including computer based instruction
In-home tutoring service
Family literacy program
Child care center serving school-age students
Regional educational consortium
School districts that are in need of improvement and have obtained a United States Department of Education (US EDDE) waiver to be providers of SES.
Other ______________ Other (Describe):
E. Academic and Instructional Information ACADEMIC AND INSTRUCTIONAL INFORMATION
1. Subject Area(s): Check all that apply. Subject Area(s) (check all that apply):
Reading/Language Arts
Mathematics
Science ________
2. Additional Staff Qualifications: Check all that apply. Additional Staff Qualifications (check all that apply):
**NOTE**: All tutorial staff must meet the minimum standards for Title I paraprofessionals, as follows:
● Title I paraprofessionals must have a secondary school diploma or its recognized equivalent; and
● Title I paraprofessionals must have at least one of the following:
Ø Completed two years of study at an institution of higher education (equivalent to 60 semester hours)
Ø Obtained an associate’s (or higher) degree
Ø Met a rigorous standard of quality and be able to demonstrate, through a formal local academic assessment, knowledge of and the ability to assist in instructing, reading, writing, and mathematics (or, as appropriate, reading readiness, writing readiness, and mathematics readiness).
Indicate tutorial staff qualifications below:
Meet the minimum standards as Title I paraprofessionals
Are qualified with a reading certification or endorsement
Current State of Florida certified teachers Are qualified as state certified or licensed teachers
Ability to communicate languages other than English
Spanish
Haitian Creole
Other (Identify) ___________
Have experience in teaching students with specific disabilities
Please specify disabilities:
Have experience in teaching students who are English Language Learners (ELL)
Have the ability to speak languages other than English
Spanish
Haitian Creole
Other (Identify):
Have experience in teaching students with visual impairments
Have experience in teaching students with hearing impairments
3. Type of Instruction: Check all that apply. Type of Instruction (check all that apply):
Individual tutoring
In-home tutoring. A parent or guardian must be present during and throughout all tutoring sessions.
Distance learning instruction (on-line, internet-based, or computer-based instruction)
Small group instruction (not to exceed a group size of five students per tutor)
Large group instruction (not to exceed a group size of eight students per tutor)
4. Grade Levels to be Served: Check all grades level you will serve for each subject area (Note: The curriculum described in the application must be appropriate for the grade levels indicated):
Grade Levels to be Served (check all that apply):
Reading/Language Arts
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Science
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F. SES Provisions
1. Student Capacity Student Capacity
_______ Indicate the minimum number of students that the applicant would serve at each site
_______ Indicate the maximum number of students that the applicant would serve in each school district
Yes No Capacity to serve students with disabilities or plans developed under section 504 of the Rehabilitation Act
Yes No Capacity to serve students who are English language learners (ELL)
Capacity to serve students with visual impairments
Capacity to serve students with hearing impairments
2. Location of Services: Check all that apply. Location of Services (check all that apply)
School campus
Provider facility
Faith-based center (for example, church, temple, or mosque.)
Community-based center
Student’s home (on-line or computer-based)
Student’s home with tutor present
Child Care Center
Public site such as public library (describe): ____________
Other (describe): _______________________________
Transportation
Will the applicant provide transportation if services are provided at a site other than the student’s school?
Yes, transportation will be provided for each student enrolled from the school to the SES site and back to the school or home. Describe transportation service to be provided:
No, transportation will not be provided to students.
G. Operations: Check all that apply. Operations (check all that apply)
1. Day(s) Services will be Provided:
Weekday (Monday – Friday)
Weekend (Saturday – Sunday)
Day(s) Services will be Provided:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Frequency of SES sessions for each student:
Every Day Once a Week Twice a Week Three Times a Week Other (Describe):
2. Length of each service session: Cumulative sessions may not exceed two hours per day or six hours per week. Length of each service session (Cumulative sessions may not exceed two hours per day or six hours per week.):
2 Hours
1 Hour
30 Minutes
Other (describe) _________________________________
Can the applicant provide a minimum of 20 hours of tutoring per student?
Yes, the applicant can provide a minimum of 20 hours per student.
No, the applicant cannot provide a minimum of 20 hours per student.
3. Times of Service Times of Service:
Before school
After school
Weekends
Summer (Identify dates, such as June 1 – August 4, 2009):
Other (Describe):
H. Cost of Service COST OF SERVICE
1. Rate for Provision of SES: Per Student, Per Hour, Per Type of Instruction
Rate for Provision of SES: Per Student, Per Hour, Per Type of Instruction
Indicate the rate to serve SES for each student per hour and for each type of instruction offered and indicated in this application under Type of Instruction. For the 2007-2008 school year, the statewide average cost per pupil for SES is $1,120. More detailed information on the cost per pupil allocation for supplemental educational services may be found at http://www.fldoe.org/flbpso/xls/perpupil-allocation0708.xls.
**Note** The allowable range is between $5 and up to $70 80 per hour for each student, per hour, and per type of instruction. RATE PER STUDENT PER HOUR:
$_______ Small group instruction (group size two to five students per tutor not to exceed five students with one tutor)
$_______ Large group instruction (group size six to eight students per tutor not to exceed ten students with one tutor)
$_______ Distance learning including computer-based instruction
$_______ Individual tutoring
$_______ In-home tutoring
III. APPLICATION NARRATIVE: To ensure an anonymous review of the application, the company name should not be included in this section.
THE FOLLOWING ITEM WILL NOT BE SCORED (0 points):
Summarize the overall proposed program in a narrative including services provided, diagnostic/prescription process, curriculum, type of instruction, mode of instruction, and major elements of the program.
THE FOLLOWING ITEMS WILL BE SCORED (0-5 points per question):
A. The provider must have a demonstrated record of effectiveness in increasing the student academic achievement toward meeting the state achievement standards [NCLB, 20 U.S.C. Section 6316(e)(12)(B)(i)].
1. Provide the Describe specific student achievement data that o document evidence that the applicant’s company or organization had a positive impact on increasing student achievement toward meeting state achievement standards. Include quantitative data that documents student learning gains.
2. Provide results of state evaluations and parent satisfaction surveys that attest to the program’s effectiveness in raising student achievement, if any exist.
B. The provider must document that the instruction provided is high quality, based upon research, and designed to increase student academic achievement of eligible students and attain proficiency in meeting the state’s academic achievement standards [NCLB, 20 U.S.C. Section 6316(e)(12)(C)(ii)].
2.3. Identify the curriculum and key instructional strategies of the proposed program and quantitative research that documents its effectiveness in increasing student achievement.
3. Identify the key instructional strategies of the proposed program and the quantitative research that documents the effectiveness of the instructional strategies in increasing student achievement. Examples of instructional strategies may include scaffolding, graphic organizers, use of manipulative resources, effective question and answer techniques, use of prior knowledge, direct instruction, directed practice, and mastery learning. For more information on effective instructional strategies, see http://www.cpt.fsu.edu/ESE/in/strmain.html.
4. Identify the major design elements of the proposed program and quantitative research that documents the effectiveness of the elements in increasing student achievement. Examples of major elements may include mode of instruction, time on task, or resource materials.
5. Identify the delivery model of the proposed program and the quantitative research that documents the effectiveness in increasing student achievement. Include academic research with specific evidence the delivery model has positive impact on increasing student achievement. Examples of delivery models include group size for instruction, direct instruction, distance learning, computer-based, individual tutoring, in-home tutoring. (NOTE: Homework assistance is not a form of SES.)
3.6. Describe how instruction will be focused, intensive, and tailored to meet the needs of individual students, including students with disabilities, students with 504 plans, and English language learners.
C. The provider must ensure that supplemental educational services are consistent with the instructional program of the local educational agency and the academic standards set forth by the state (Sunshine State Standards) [NCLB, 20 U.S.C. Sections 6316(e)(5)(B) and 6316(e)(12)(B)(ii)].
4.7. Describe the process the applicant will use to ensure that the the alignment of the proposed curriculum with is correlated to the Sunshine State Standards for each grade level and content area you plan to serve. For information on Florida’s Sunshine State Standards, see http://www.fldoe.org/bii/curriculum/sss/.
5.8. Describe the process the applicant will use to ensure the proposed program aligns with the instructional program of the school district(s) in which the applicant intends to serve students. Cite at least one example of the correlation of the proposed program and describe its integration with at least one district that the applicant intends to serve.
6.9. Describe how the process to ensure that the applicant will coordinate supplemental educational services with the classroom instructional program of the students receiving the services. Describe the specific methods, tools, and processes that will be used to execute this coordination.
D. The provider must set measurable achievement goals for each student in consultation with each student’s parents and the school district and adhere to the timetable for improving the student’s achievement in the student learning plan. The provider must measure the student’s progress, and regularly inform the student’s parents and teachers regarding the progress of the student in improving academic achievement as outlined in the student learning plan [NCLB, 20 U.S.C. Sections 6316(e)(3)(A) and (B)].
7.10. Describe how diagnostic assessment data will be used to identify the student’s knowledge and skills gaps and set measurable goals for the student learning plan.
8.11 Identify the specific assessment to be administered if district student data are not available for developing the student learning plan. Describe the specific pre- and post-assessments that will be used and the alignment to the Sunshine State Standards.
11. Describe the process and timelines for the development of the student learning plan.
9.12. Describe the procedures and timelines to be used to evaluate, monitor, and report, at a minimum monthly, each student’s progress toward meeting the goals as stated on the student learning plan. Address how applicant ensures that the progress reports are understandable to parents and in parents’ native language, if feasible. Include frequency of progress reports to student’s parents, teachers, and appropriate school district staff.
13. Describe how student attendance and participation data will be collected, verified, and reported to the school district. Include strategies for improving attendance of students who are habitually absent.
14. Describe the process and timelines the applicant will use to ensure that services begin no later than October 15th of each school year. Include steps and timelines the applicant will implement from approval of the application to the provision of services to students.
E. The provider must have the capacity and resources, including financial soundness and compliance with applicable federal, state, and local health, safety, and civil rights laws and regulations, to provide supplemental services to students [NCLB, 20 U.S.C. Sections 6316(e)(12)(B)(iii) and (e)(5)(C)].
10.15. Describe the applicant’s infrastructure, including resources such as personnel, buildings, or equipment, and capacity to ensure services begin no later than October 15th of each school year. Include roles and responsibilities of staff within the organization.
16. Describe the process for recruiting, hiring, and initial training of staff.
11.17. Describe the initial training, professional development, and ongoing support provided to tutors to ensure that the proposed program is implemented with fidelity.
12.18. Describe procedures for supervising tutors to ensure the proposed program is implemented with fidelity and that all employees comply with ethical business practices pursuant to assurances found in the Request for Application, such as behavior at provider fairs, quality of tutoring services, and effectiveness of instruction.
13.19. Describe the process and procedures for monitoring the program to ensure the proposed program is implemented with fidelity, such as tutor/student ratio, supervision of students, approved instructional materials, students on task, or beginning services on time.
20. Describe procedures to be used to ensure that all staff providing direct services to students or having access to school grounds comply with fingerprint-based background screening pursuant to Section 1012.465, Florida Statutes (Background screening requirements for certain noninstructional school district employees and contractors). For more information, see the related Technical Assistance Paper at http://www.fldoe.org/flbpso/pdf/tap_fingerprint.pdf.
IV. FINANCIAL SOUNDNESS – No change.
A. through F. No change.
G. Evidence of financial soundness:
If an applicant has been in business for two or more consecutive years submit:
Financial statements in the form of an income statement for the past two years
OR
Financial audits signed by a certified public accountant for the past two years
If the applicant has been in business for less than two consecutive years submit:
Federal income tax returns of a member of the board of directors, a managing member, or chief officer for the past two years
AND
Documentation from a financial institution showing three months of operating expenses in the form of a line of credit, loan, or a pre-approved loan on behalf of the company
AND
List and submit on attached Three Months Projected Expense Report projected expenses to operate SES in Florida for three months. Expenses should include, but not be limited to, information on the resources to cover the costs of salaries, fingerprinting/background screening, insurance policies, instructional materials, marketing, professional development, and facility rental fees. The total projected expenses on the report should match, at a minimum, the amount of the line of credit, loan, or pre-approved loan secured from a financial institution.
Cover Page
Financial Soundness
Copy of general liability insurance with the Department of Education listed as the certificate holder
Copy of evidence of fiscal soundness:
Annual financial statements or fiscal audits
or
Federal income tax returns and financial letter of credit
Evidence of legal qualification to do business in Florida
Verification of business or non-profit status
Signed notarized statements on agency letterhead regarding the organization’s (each required):
Suspension or disbarment from receiving federal funding
Any lawsuits filed against organization
Denial of approval or removed from approval status from another state
Unresolved complaints with the Better Business Bureau
List of the Board of Directors or chief officers of the organization, and their titles
Assurances with original signature
Attachment A
Attachment B
FINANCIAL SOUNDNESS
To prove financial soundness, applicants must mail or hand deliver a copy of the following documents to the Bureau of Public School Options at FDOE.
Note: Public schools and school districts need only submit supporting documentation for 1, 5, and 6.
1. Evidence of applicant’s current commercial general liability insurance in the form of a certificate of insurance with the Department of Education, Bureau of Public School Options listed as the certificate holder. The name of the applicant must match the name on the certificate.
2. Evidence of the applicant’s fiscal soundness. Submit:
● annual financial statements or fiscal audits signed by a certified public accountant for the past two years, or
● federal income tax returns for the past two years along with a letter of credit from a financial institution.
3. A copy of the most recent registration with the Florida Department of State (www.sunbiz.org), showing evidence that the applicant is legally qualified to do business in Florida.
4. Verification of business status or non-profit status. For example, an Internal Revenue Service (IRS) letter with FEIN or certificate issued by government.
5. Signed notarized statements on applicant’s letterhead by the individual authorized to act on behalf of the organization attesting to the following:
● The organization has not been suspended or disbarred from receiving federal funding. If yes, explain the circumstances for suspension or disbarment.
● The organization has had no lawsuits filed against them for educational or fiscal mismanagement, civil rights violations, criminal acts, or other reasons. If yes, provide information and the outcome for each instance.
● The organization has not been denied approval nor has its approval status as an SES provider been revoked. If the organization has been denied approval or its approval status as an SES provider has been revoked, identify such state(s) or district(s) and the reason(s) for such denial or revocation.
● The organization does not have any unresolved complaints with the Better Business Bureau or FDOE. If the organization does have any known unresolved complaints, provide an explanation of the complaint(s) and results.
6. A complete list of the board of directors and chief officers of the organization and their titles.
Three Months Projected Expense Report – No change.
V. ATTACHMENT A: GENERAL ASSURANCES
Execution Requirements
The assurance pages must contain no revisions, additions, or deletions, and must bear an original signature of the agency head in blue ink to distinguish it from a copy or facsimile. The printed name and original signature must match.
Assurances signed by officials other than the head of the providing agency must have a letter signed by the agency head, or documentation citing action of the governing body delegating authority to the person to sign on behalf of said official.
As the duly authorized representative of this applicant, I certify agreement and compliance with all of the following assurances and conditions: (No Change items 1-23)
I, THE UNDERSIGNED, CERTIFY that I am an individual authorized to act on behalf of the organization in submitting this application and assurances and that all of the information provided herein is true and accurate, to the best of my knowledge. I understand that, if any of the information contained herein has been misrepresented, that may constitute grounds for denying the applicant’s request for approval to be placed on the list of approved supplemental educational services providers or for removal from that same list. I further certify that the organization will comply with all of the assurances set forth herein. Failure to comply with the assurances during the school year may result in removal from the state-approved list and potential ineligibility to re-apply during the following two-year period.
___________________ ___________________________
Signature of Applicant Date signed
___________________ ___________________________
Printed Name Name of Agency/Company/Group
____________________________________
Title of Signing Agent
Note:
1. Printed name and original signature must match.
2. Use blue ink color for original signature.
3. “By”, “for,” or initials will not be accepted.
4. Rubber stamp signatures will not be accepted.
24. Applicant assures that it has not been removed and permanently barred from providing supplemental educational services in any state or district.
25. Applicants who selected to serve students at Florida School for Deaf and Blind and indicated a capacity to serve students with visual impairments assures that it will provide transcription of materials into large print and Braille.
26. Applicants who selected to serve students at Florida School for Deaf and Blind and indicated a capacity to serve students with hearing impairments assures that it will provide tutors fluent in American Sign Language.
27. Applicant assures that all tutorial staff meet the minimum standards for Title I paraprofessionals, as follows:
● Title I paraprofessionals must have a secondary school diploma or its recognized equivalent; and
● Title I paraprofessionals must have at least one of the following:
§ Completed two years of study at an institution of higher education (equivalent to 60 semester hours)
§ Obtained an associate’s (or higher) degree
§ Met a rigorous standard of quality and be able to demonstrate, through a formal local academic assessment, knowledge of and the ability to assist in instructing, reading, writing, and mathematics (or, as appropriate, reading readiness, writing readiness, and mathematics readiness).
28. Applicant assures that cumulative sessions shall not exceed two hours per day or six hours per week.
29. Applicant understands that the allowable range is between $5 and up to $70 per hour for each student, and per type of instruction.
ATTACHMENT B: INTERNET STATEMENT OF ASSURANCES
Execution Requirements
The assurance pages must contain no revisions, additions, or deletions, and must bear an original signature of the agency head in blue ink to distinguish it from a copy or facsimile. The printed name and original signature must match.
Assurances signed by officials other than the head of the providing agency must have a letter signed by the agency head, or documentation citing action of the governing body delegating authority to the person to sign on behalf of said official.
The following guidelines define appropriate use of the Internet. 30. Applicant understands that tTransmitting any material in violation of any U.S. or state regulation or school board policy is prohibited. This includes, but is not limited to, copyrighted material and threatening or obscene material.
31. Applicant understands that aAll content transmitted via e-mail or the Internet shall be secular, neutral, and non-ideological.
32. Applicants providing on-line instruction agree to ensure the safety of all students while accessing the internet. It is the responsibility of the applicant to block all unsafe web content.
33. Applicant understands that hHate mail, harassment, discriminatory remarks, and other antisocial behaviors are unacceptable in Internet and other network communication.
34. Applicant understands that aAll information accessible via the Internet should be assumed to be private property and subject to copyright protection. Internet sources should be credited appropriately, as with the use of any copyrighted material.
35. Applicant has a responsibility to respect the privacy and property of students. Applicant should not intentionally seek information about, obtain copies of, or modify, files, data, or passwords of other users.
36. For the safety of students, applicant must not request or provide any personal information, such as addresses, phone numbers, or photographs.
37. Applicant should not expect that files are private. State and school district representatives, including school administrators, as well as parents, may review files and communications at any time to ensure that the network is being used responsibly. Applicant must gain written parental permission before communicating with students under the age of 13 via e-mail or the Internet.
38. Applicant has a responsibility to protect the student users from marketing and Spam.
39. Applicants shall ensure that the primary purpose of a computer in the SES program is instructional. all computer equipment provided to When a computer provided by the applicant is used for instructional purposes, the student is allowed to keep the computer is returned to the applicant upon completion of SES. If students will be using a school computer to access information from an applicant, the applicant must abide by all school and school district policies and procedures regarding computer/Internet use.
40. Applicant agrees to comply with all assurances set forth in this application.
I, THE UNDERSIGNED, CERTIFY that I am an individual authorized to act on behalf of the organization in submitting this application and assurances and that all of the information provided herein is true and accurate, to the best of my knowledge. All tutors/instructors employed by this organization will be notified of all guidelines regarding appropriate use of the Internet and that as a condition of employment with the provider, all employees who will provide SES shall agree to comply with the guidelines. I understand that, if any of the information contained herein has been misrepresented, that may constitute grounds for denying the applicant’s request for approval to be placed on the list of approved supplemental educational services providers or for removal from that same list. I further certify that the organization will comply with all of the assurances set forth herein. Failure to comply with the assurances during the school year may result in removal from the state-approved list and potential ineligibility to re-apply during the following two-year period.
I, the undersigned, agree that all tutors/instructors employed by this organization will be notified of all guidelines regarding appropriate use of the Internet and that as a condition of employment with the provider, all employees who will provide SES shall agree to comply with the guidelines. Failure to comply with the assurances during the school year may result in removal from the state-approved list and potential ineligibility to re-apply during the following two-year period.
___________________ _________________________
Signature of Applicant Date signed
___________________ _________________________
Printed Name Name of Agency/
Company/Group
____________________________________
Title of Signing Agent
Note:
1. Printed name and original signature must match.
2. Use blue ink for original signature.
3. “By”, “for,” or initials will not be accepted.
4. Rubber stamp signatures will not be accepted.