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: The principal, director, or other chief operating officer of an open-enrollment 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. TYPED NAME OF CHIEF OPERATING OFFICER OF SCHOOL SIGNATURE DATE TYPED NAME OF CHIEF OPERATING OFFICER OF CHARTER HOLDER SIGNATURE DATE 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. 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: __________________________________________________________________ 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): ____________________________________________ 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. 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.