_____________________________                                                   ___________________________
CHARTER SCHOOL NAME                                                    COUNTY-DISTRICT NUMBER
TEXAS EDUCATION AGENCY
Division of Charter Schools

Open-Enrollment Charter School Annual Governance Reporting

Authority for Data Collection: Texas Education Code, Sections 12.107 and 12.119.

Planned Use of the Data: In support of ensuring the fiscal and academic accountability of persons holding charters issued under Subchapters D and E, Chapter 12, Texas Education Code.

Instructions
Charter holders should complete and attach the Open-Enrollment Charter School Annual Governance Reporting Data Collection Sheet to this form.

Charter holders should attach a copy of the required bank depository contract(s) to this form. (Section 12.107 of the Texas Education Code requires that funds received by a charter holder from the State after September 1, 2001 be deposited into a bank with which the charter holder has entered into a depository contract.)

If the governing body of the charter holder has delegated authority to a charter school governing body, the information required must be provided for members of both governing bodies.

Note the definitions provided below and listed in Texas Education Code, Sections 12.1012 and 45.201 for: charter holder; governing body of a charter holder; governing body of an open-enrollment charter school; officer of an open-enrollment charter school; and bank.

Definitions:

· Bank: a bank, a savings and loan association, or a savings bank organized under the laws of this state, another state, or federal law that has its main office or a branch office in this state. The term does not include any bank the deposits of which are not insured by the Federal Deposit Insurance Corporation.

· Charter holder: the entity to which a charter is granted under Subchapters D and E, Chapter 12, Texas Education Code.

· Governing body of a charter holder: the board of directors, board of trustees, or other governing body of a charter holder.

· Governing body of an open-enrollment charter school: the board of directors, board of trustees, or other governing body of an open-enrollment charter school. The term includes the governing body of a charter holder if that body acts as the governing body of the open-enrollment charter school.

· Officer of an open-enrollment charter school:


o The principal, director, or other chief operating officer of an open-enrollment charter school;
o an assistant principal or assistant director of an open-enrollment charter school; or
o a person charged with managing the finances of an open-enrollment charter school.

____________________________________________________________________________________________________________
TYPED NAME OF CHIEF OPERATING OFFICER OF SCHOOL           SIGNATURE                               DATE

____________________________________________________________________________________________________________
TYPED NAME OF CHIEF OPERATING OFFICER OF CHARTER HOLDER           SIGNATURE                               DATE



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CHARTER SCHOOL NAME                                                    COUNTY-DISTRICT NUMBER

Open-Enrollment Charter School Annual Governance Reporting Data Collection Sheet

This page should be duplicated in order to provide information for members of governing bodies and charter school officers. Mail or fax completed forms and attached depository contracts to the address and fax number provided below.

Section I. Governing Body of the Charter Holder

Name of individual:_____________________________________________________

Position held on board, if any (e.g., president or secretary):______________________

Full mailing address:________________________________________________________________________________

Telephone numbers:_____________________________________________________

Amount of annual compensation received from the open-enrollment charter school, if any:___________
Optional information-Other means of contact (fax, e-mail address):______________ _____________________________________________________________________

Section II. Governing Body of the Open-Enrollment Charter School


Note: This section of the report is applicable only if the governing body of the charter holder has delegated authority to a separate charter school governing body.

Name of individual:_____________________________________________________

Position held on board, if any (e.g., president or secretary):______________________

Full mailing address:____________________________________________________________________________

Telephone numbers:_____________________________________________________

Amount of annual compensation received from the open-enrollment charter school, if any:___________ Optional information-Other means of contact (fax, e-mail address):_______________ ______________________________________________________________________

Section III. Officers of the Open-Enrollment Charter School

Name of individual:_____________________________________________________

Title:_________________________________________________________________

Full mailing address:______________________________________________________________________________

Telephone numbers:______________________________________________________

Amount of annual compensation received from the open-enrollment charter school, if any:____________
Optional information-Other means of contact (fax, e-mail address):________________ _______________________________________________________________________


_____________________________                                                   ___________________________
CHARTER SCHOOL NAME                                                    COUNTY-DISTRICT NUMBER

Section IV. Open-Enrollment Charter School and Charter Holder Contact Information

Note: Charter holder is the entity to which a charter is granted under Subchapters D and E, Chapter 12, Texas Education Code.

Name of charter school:_________________________________________________

Charter school full mailing address:__________________________________________________________________

Name of charter holder:_________________________________________________

Charter holder full mailing address:___________________________________________________________________

Charter holder contact name:_____________________________________________

Charter holder phone number: ____________________________________________

Charter holder fax number:_______________________________________________

Charter holder e-mail address:_____________________________________________

Return by November 1, 2001, to:
Texas Education Agency
Division of Charter Schools
1701 North Congress Avenue
Austin, TX 78701-1494          Fax: 512-463-9732           Contact Ertha Patrick at 512-936-2624 with questions.