PI-PPSCP-1ParentalPrivateSchoolChoiceProgramNoticeof.docVIP

Page  PAGE 2 PI-PPSCP-1 PI-PPSCP-1 Page  PAGE 3 Wisconsin Department of Public Instruction PARENTAL PRIVATE SCHOOL CHOICE PROGRAM NOTICE OF SCHOOL’S INTENT TO PARTICIPATE 2013-14 SCHOOL YEAR PI-PPSCP-1 (Rev. 11-12)INSTRUCTIONS: Submit completed and signed form, to arrive at DPI no later than FEBRUARY 1, 2013, to: WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION ATTN: TRICIA COLLINS PARENTAL PRIVATE SCHOOL CHOICE PROGRAM P.O. BOX 7841 MADISON, WI 53707-7841Collection of this information is a requirement of s. 118.60, Wis. Stats.TYPE OR PRINTGENERAL INFORMATIONSchool Name  FORMTEXT
?????School Year 2013-14Address for Each School Location Street, City, State, ZIP Attach additional sheet if necessary.  FORMTEXT
?????Mailing Address If different than above  FORMTEXT
?????Phone Area/No.  FORMTEXT
?????Fax Area/No.  FORMTEXT
?????Choice Administrator’s Name  FORMTEXT
?????Title  FORMTEXT
?????E-Mail Address  FORMTEXT
?????Choice Administrator Address, Other than School Street, City, State, Zip  FORMTEXT
?????Under s. 118.60(2)(a)6.b. Wis. Stats., administrators of private schools participating in the Parental Private School Choice Program (PPCSP) must have at least a bachelor’s degree from an accredited institution of higher education. Check “Yes” if the administrator meets this requirement and provide the name of the accredited institution of higher education and month and year the bachelor’s degree was received. Check “No” if the administrator does not meet this requirement. A private school that does not comply with this requirement is ineligible to participate in or receive funding under the PPCSP. If any of the information provided in answer to this question is found to be incorrect or misrepresented, the private school will not be eligible to participate in or receive funding under the PPCSP. FORMCHECKBOX
 Yes  FORMCHECKBOX
 No The administrator listed above has at least a bachelor’s degree from a