Charter School Fellowship Statement of Intent

Application Instructions

  • Complete sections I-III.
  • Attach your resume and the resumes of your leadership team members.

Please choose one of the following:

☐Should I be invited, I intend to apply to the Charter School Fellowship with a new school model.

☐Should I be invited, I intend to apply to the Charter School Fellowship to replicate a successful school model.

I.Personal Background

First Name
Middle Initial
Last Name
Mailing Address
City
State
Zip Code
Cell Phone
Email Address

NOTE: If more than one person is applying for a single fellowship, copy and complete the above section and submit a resume for each team member.

Professional Background

Company/Organization Title City/Location Dates From/To

Community Leadership Experience

Please list up to three community and/or volunteer activities in which you have participated, starting with the most significant and most relevant to your proposed idea for the Fellowship.

Organization/Effort Position/Responsibility City/Location Dates From/To

Awards/Honors/Publications

Please list up to five awards, honors, and/or publications, starting with the most significant and most relevant to your proposed idea for the Fellowship.

Award/Honor/Publication Date Additional Information

II.School Vision and Mission

Describe your vision for your charter school in 500 words or fewer. Be sure to answer the following questions in your school overview:

  • What are the basic components of your school design?
  • What informs your school design? (I.E. Why have you designed the school the way you have?)
  • What does your school aim to achieve?

Describe the mission of your charter school in 500 words or less. Please include:

• Your school’s mission statement

• How will your school achieve the vision outlined above?

• What will a typical day look like for a student?

Please complete the chart below based on your current best thinking. Narrative or additional context can be offered in the box below the chart.

Year / Grades Served / Number of Students Enrolled
Year 1
Year 2
Year 3
Year 4

Any narrative for grade configuration and student enrollment:

Please check your proposed year of school launch below:

1)Fall 2019

2)Fall 2020

3)Fall 2021

4)Other ______

III. Student Achievement

If you intend to open a new school: 1) Provide presentation of your school’s/classroom’s data as a school leader or teacher and provide evidence of advancing student proficiency and 2) your goals for student growth and performance in the first five years of your school’s launch. Please use a range of quantitative measures, including the most recently released data.

If you intend to replicate an existing school: 1) Provide presentation of your existing school(s)’s data and evidence of advancing student proficiency and growth, 2) the results you have achieved at your school(s), and 3) your continued goals for student growth and performance in your existing school as well as in the first five years of your new school’s launch. Please use a range of quantitative measures, including the most recently released data.

Note: Indiana operators and school leaders should include historical and most recent data from ISTEP+, IREAD+, NWEA, and Indiana Report Card.

IV.Next Steps

You will be notified of whether you have been invited to submit a Full Application within 3 weeks of submitting your Statement of Intent. For additional information, visit Please email questions .

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