Spreadsheet: 47e2f26e-07aa-4d47-bf74-40cda4d4ddf6
Sheet: SUMMARY_FILE

 | A school that wishes to be designated for the first time as an Alternative Education Campus or to renew its designation as an Alternative Education Campus  must submit the following application verifying that the school meets eligibility criteria no later than April 4, 2014. Please complete the following application in electronic format, as well as a PDF of this Summary File tab with necessary signatures, and submitvia our secure FTP server located here: https://transfer.cde.state.co.us/bds/Login.do.  If you need help with the FTP server, you may find instructions here: https://transfer.cde.state.co.us/bds/images/include/CDE_SFTS_Instructions.pdf or [PHONE]. As a reminder, to comply with FERPA guidelines, student data cannot be emailed and must be submitted via the FTP server.
 | 2014-2015 APPLICATION/RENEWAL FOR ALTERNATIVE EDUCATION CAMPUS DESIGNATION
 | Based upon the school and student characteristics indicated below, we certify that
 |  |  |  |  |  |  | in
 | School Name |  |  |  |  | CDE School # |  | District Name
 | meets the requirements specified in Section 22-7-604.5, CRS, and we request Colorado State Board of Education designation of this school as an Alternative Education Campus for the 2014-15 school year.
 | We certify that this school meets the below criteria:
 |  |  | Has a specialized mission to serve special needs or at-risk populations
 |  |  | Is an autonomous public school, meaning that the school provides a complete instructional program that allows students to proceed to the next grade level or to graduate
 |  |  | Has an administrator who is not under the supervision of an administrator at another school
 |  |  | Has a budget separate from any other public school
 |  |  | Has nontraditional methods of instruction delivery
 |  |  | Has a public process to ensure accountability
 |  |  | Serves one of the following student populations (at the time of the 2013 October Count Administration):
 |  |  |  | All students have severe limitations that preclude appropriate administration of the assessments administered pursuant to section § 22-7-409, C.R.S.;
 |  |  |  | All students attend only on a part-time basis and come from other public schools where the part-time students are counted in the enrollment of the other public school ; or
 |  |  |  | More than 95% of students have either an Individualized Education Programs (IEPs) pursuant to § 22-20-108, C.R.S. and/or meet the definition of a “high-risk” student as illustrated on the following page.
 | School Principal/Administrator Name (Type or Print) |  |  |  |  | School Principal/Administrator Signature |  |  |  | Date
 | School District Superintendent Name (Type or Print) |  |  |  |  | School District Superintendent Signature |  |  |  | Date
 | School District Board President Name (Type or Print) |  |  |  |  | School District Board President Signature |  |  |  | Date
 | CERTIFICATION OF STUDENT POPULATION
 | This page only needs to be completed if you checked the box indicating that 95% of your school’s students have Individualized Education Programs (IEPs) or are deemed “high-risk.” The Student File tab in this document has been pre-populated for you and includes only those students present at the time of the 2013 Student October Count in certain "high-risk" categories. Please fill in additional "high-risk" categories for your student population in the Student File tab and they will be counted on this page. Nothing can be entered on this page and must be entered in the Student File Tab. Although students may fall into more than one "high-risk" category, each student will only be counted ONCE in the bolded rows 16-18.
 | District Accountability Contact (to verify information submitted on this page):
 | Name: |  |  |  | [NAME]: |  |  |  | Phone:
 |  | Student Population |  |  |  |  |  |  |  | # of students
 | 1 | # of students who have Individualized Education Programs (IEPs)
 | 2 | # of students who have been committed to the Department of Human Services following adjudication as juvenile delinquents or who are in detention awaiting disposition of charges that may result in commitment to the Department of Human Services
 | 3 | # of students who have dropped out of school or who have not been continuously enrolled and regularly attending any school for at least one semester prior to enrolling in this school
 | 4 | # of students who have been expelled from school or who have engaged in behavior that would justify expulsion
 | 5* | # of students who have documented histories of personal drug or alcohol use or who have parents or guardians with documented dependencies on drugs or alcohol
 | 6* | # of students who have documented histories of personal street gang involvement or who have immediate family members with documented histories of street gang involvement
 | 7* | # of students who have documented histories of child abuse or neglect
 | 8* | # of students who have parents or guardians in prison or on parole or probation
 | 9* | # of students who have documented histories of domestic violence in the immediate family
 | 10* | # of students who have documented histories of repeated school suspensions
 | 11* | # of students under the age of twenty years who are parents or pregnant women
 | 12 | # of students who are migrant, as defined in Section 22-23-103 (2), CRS
 | 13 | # of students who are homeless, as defined in Section 22-1-102.5 (2), CRS
 | 14* | # of students who have a documented history of a serious psychiatric or behavioral disorder, including but not limited to an eating disorder, suicidal behaviors or deliberate, self-inflicted injury
 | 15** | # of students who are over traditional school age for their grade level and lack adequate credit hours for their grade level
 | 16 | Total # of high risk students (meeting at least one criteria 1–15)
 | 17 | School’s total student population
 | 18 | Total % of high-risk students (row 16 divided by row 17)
 | *View district assurance information for students identified in idicators 5-11 & 14 on the Documentation Assurance tab in this document. **View Over Age and Under [NAME] in this document for more information on how to report on these students.
 | SCHOOL MISSION
 | Statement of School Mission:
 | Description that most closely mirrors your school’s mission and student population (select all that apply)
 |  |  | Adult Education
 |  |  | College Prep
 |  |  | Credit Recovery
 |  |  | Detention Center
 |  |  | [NAME]
 |  |  | Expulsion Center
 |  |  | IEP
 |  |  | Migrants/ELL
 |  |  | On-line
 |  |  | Part-time
 |  |  | Pregnant/parenting students
 |  |  | Transition Center
 |  |  | Vocational/Technical
 |  |  | Wrap-around to graduate
 | ADDITIONAL SCHOOL INFORMATION
 |  |  |  |  |  |  |  | Select Yes/No
 | Is your school a dropout-retrieval program? |  |  |  |  |  |  | Yes |  | No
 | Is your school intended to transition students back to their home school? |  |  |  |  |  |  | Yes |  | No
 | Does your school award diplomas? |  |  |  |  |  |  | Yes |  | No