2012 Chapter PI 35 – Milwaukee Parental Choice Program Page 3

/ Wisconsin Department of Public Instruction
PRIVATE SCHOOL CHOICE PROGRAMS (PSCP)
PRIVATE SCHOOL–ALL STUDENTS REPORT CARD
PCP-116 (Rev. 02-18) / INSTRUCTIONS: Completed form is due at the Department of Public Instruction no later than August1, 2018.
Email to:
Collection of this information is a requirement of Wis. Stats. §115.385(3).
All private schools participating in a PSCP will receive a Private School–Choice Students Report Card. A Private School–Choice Students Report Card means a report card issued under §115.385(3), Wis. Stats., for choice students at the private school.
All private schools participating in a PSCP can additionally opt to have a Private School–All Students Report Card. A Private School–All Students Report Card means a report card issued under §115.385(3), Wis. Stats., for all students, choice and nonchoice, at the private school.
A private school participating in a program under §§118.60 or 119.23, Wis. Stats., that opts to receive a Private School–All Students Report Card agrees to all of the following:
·  The school will assign all students in the school a unique identifier, called a WISEid, which will be used in DPI’s data collection system.
·  The school will administer, pay for, and submit performance and participation results for all nonchoice students for all state required assessments regardless if the school has Choice students in that grade. Parents may opt their child(ren) out of the state required assessment as provided by state law.
·  The school will submit to the DPI student-level data elements needed to produce a Private School–All Students Report Card such as enrollment, attendance, high school completion (if applicable), dropout, and student demographic data for all students.
·  The school will need to submit a minimum of two consecutive years of data for its nonchoice students before a Private School–All Students Report Card will be issued. The DPI will issue a Private School–All Students Report Card if there is sufficient data to calculate a score.
·  The school will inform all the parents of nonchoice students that the school has opted to have a Private School–All Students Report Card and that student-level data for nonchoice students will be submitted to the DPI for report card purposes.
GENERAL INFORMATION
School Name / Phone Area/No.
School Address Street, City, State, Zip
School Mailing Address If different than above
Choice Administrator’s Name / Title / E-Mail Address
AGREEMENT / SIGNATURE
Yes, the private school listed above will opt to have a Private School–All Students Report Card
BY SIGNING THIS AGREMENT, I will abide by all requirements listed above and under state law. I also acknowledge that this agreement will stay in effect until the school submits a new form. This form applies to all locations included on the Notice of School's Intent to Participate. A new form may be submitted annually by August 1 and will first apply for that school year’s data. Agreements cannot be modified mid-year.
Choice Administrator’s Signature
Ø / Date Signed Mo./Day/Yr.
OR
No, the private school listed above will not opt to have a Private School–All Students Report Card
BY SIGNING THIS AGREMENT, I acknowledge we are opting out of the Private School–All Students Report Card starting with the 2018-19 school year’s data. I also acknowledge that this agreement will stay in effect until the school submits a new form. This form applies to all locations included on the Notice of School's Intent to Participate. A new form may be submitted annually by August 1 and will first apply for that school year’s data. Agreements cannot be modified mid-year.
Choice Administrator’s Signature
Ø / Date Signed Mo./Day/Yr.