ࡱ>  ],bjbjVV %<< $Pxx$P/|-iWmf f f hhhhhhhkm`h#D "f ##hhy'y'y'#Rhy'#hy'y'8afP9RI$Rc6hh0-iRcrn$nlfnff hy'`!T!Cf f f hhy&f f f -i####nf f f f f f f f f x :  APPLICATION FOR APPROVAL TO OPERATE AN ALTERNATIVE EDUCATION PROGRAM WITHIN A STATE AGENCY, PUBLIC COLLEGE OPERATED PROGRAM OR DEPARTMENTS APPROVED SCHOOL This application is required in accordance with N.J.A.C. 6A:16-9.1(b) to operate an alternative education program within a State agency, public college operated program or department-approved school approved by the Commissioner of Education. School district operated programs are not approved by the Department of Education; approval of such programs is the responsibility of the district Board of Education (N.J.A.C. 6A:16-9(a).. Instructions: Applications must be submitted six-months prior to the planned start date of the program. Submit two (2) copies of the complete application, including one bearing an ORIGINAL signature to: ӣƵ Department of Education ATTN: Alternative Education Program Administrator Office of Student Support Services 100 Riverview Plaza, PO Box 500 Trenton, NJ 08625-0500 Submit one (1) copy of the complete application to the County Office of Education where the facility is located. Obtain address at:  HYPERLINK "http://www.state.nj.us/education/counties/" www.state.nj.us/education/counties/. I. GENERAL INFORMATION Agency Type: (Check one.) ( State Agency ( Public College Operated Program ( *Department-Approved School ( Special Services School District (e.g. private school for the disabled) *Please attach documentation of approval for department-approved schools Applicant NameAddress (Street, City, Zip) CountyTelephone (Area/No.)Fax (Area Code/No.) Address of proposed site [if different from the address in section 2] (Street, City, Zip) CountyTelephone (Area Code/No.)Fax (Area Code/No.)  Alternative Education Program Contact Person (Name/Title)Telephone (Area Code/No.) Anticipated Program Enrollment #Anticipated Starting Date of Program  II. TARGET STUDENT POPULATION TO BE SERVED Grade level to be served (Check at least one): Middle School High School Population to be served (Check at least one): General Education Special Education *Note: Special Services School Districts may only establish alternative education programs that serve special education students. Targeted Program Focus (Check all that apply) Students: Who have dropped-out With substance abuse issues Removed from general education program per state mandate With insufficient credits to graduate With high absenteeism Who are re-entering from the criminal justice system With behavioral issues With academic performance below grade levelTarget Sending District(s) (list) (*Include a letter of intent from the chief school administrator of each proposed sending district)  III. ASSURANCES The applicant hereby provides assurance to the Commissioner of Education that: The applicant will implement the alternative education program, as described in the approved application and in accordance with N.J.A.C. 6A:16-9. The applicant shall ensure that curriculum and instruction are designed and delivered in such a way that all students are able to demonstrate the knowledge and skills specified by the Core Curriculum Content Standards (N.J.A.C. 6A:8) and allow the student full opportunity to fulfill the sending school districts graduation requirements. The applicant will communicate with the sending school district(s) and the students parent(s) in its development and implementation of the Individual Program Plan. The applicant will notify the Chief School Administrator and principal from the sending district regularly on the progress, status, and credits achieved for each student. The applicant will obtain certificates of fire inspection and, if applicable, health, sewerage plant and health, ventilation, and air conditioning (HVAC) inspections on an annual basis and shall be available upon request for review by the Department of Education. The alternative education program is separate and distinct from all other educational programs operated by the agency. All staff has met the criminal history requirements in accordance with N.J.S.A. 18A: 6-7.1. IV. SIGNATURE I HEREBY CERTIFY that this project application will be the basis for the operation and administration of an Alternative Education Program as required at N.J.A.C. 6A:16-9. I will provide expenditure and other reports as required by the ӣƵ Department of Education and agree to comply with the assurances outlined herein. I further certify that this application is complete and accurate to the best of my knowledge. Agency Administrator SignatureDate Signed (Mo./Day/Yr.) V. APPLICATION NARRATIVE Please respond to the following items in not more than two typewritten (12 pt. font) pages for each section. Use the numbers and section headings below: NEED This section identifies the local conditions and/or needs that justify the program. All applicants must: Describe the need for the alternative education program, including available data; and How the proposed program will address the identified needs. The type of students who will be served by the proposed program. PROGRAM DESCRIPTION. This section provides a detailed description of the proposed program and the plan for implementation. All of the following must be provided in this section: An outline of the measurable goals, objectives, activities and related timelines related to student outcomes; A description of how the proposed program will ensure alignment with the Core Curriculum Content Standards; A description of the educational methods and materials used to achieve the instructional objectives; A description of the strategies that will be employed to promote a high attendance rate, support student engagement and help students meet the graduation requirements; A proposed program schedule; A description of the supportive services (e.g., counseling, health services, and substance awareness support) that will be available to students and the families of those students enrolled in the program; A description of how the proposed program will facilitate a positive school climate (including, but not limited to social emotional and character development, service learning, etc); A description of how the students will be transported to the proposed site; If applicable, a description of how the program will involve other entities (e.g., multiple schools, multiple districts or community collaborators) in order to efficiently serve students; and A description of how the applicant intends to facilitate parental involvement for proposed program. ENTRANCE/EXIT CRITERIA. This section provides a description of the processes used to identify eligible students for the alternative education program and transition them back to their general education program. All of the following must be described in this section: The mechanism that will be used to identify and refer students to the program; the selection criteria and the placement procedures to be used when placing a student in the program (explain the differences, if any, in the referral processes used by different schools that may refer students to the program); How the Individual Program Plans (IPP) will be created, monitored and annually reviewed by the alternative education program and the sending school district; and The procedures to be used to facilitate the transition from school-to-work or post-secondary training and education, and/or to return students who have or have not achieved program objectives to the districts regular program, when suitable. STAFFING. This section describes the staffing to be employed in the proposed program. Describe all of the following: How the proposed program will provide sufficient staff to teach and oversee the program, include the teacher to student ratio for each grade level in accordance with N.J.A.C. 6A:16-9.2(a)1 and 2 (maximum student teacher ratio 12:1 for high school and 10:1 for middle school); How the proposed program will provide professional development opportunities to staff that reflect the unique needs of working in an alternative education program setting; The procedures for supervising and evaluating the alternative education program; The titles, certifications and/or endorsements, and names, if applicable, of all teaching and support staff who will work in the program (e.g., teachers, school aides, teacher assistants, counselors), including those that are Highly Qualified in accordance with N.J.A.C. 6A:9 and N.J.A.C. 6A:8-5.1; and The responsibilities of the administrative, supervisory, and instructional staff, including community resource persons, as appropriate to the program. EVALUATION. This section describes the method in which the proposed program will be assessed and evaluated. Address the following: How student progress and grade level attainment will be assessed; and How the program will monitor and evaluate its own effectiveness. VII. REQUIRED CERTIFICATES Please provide information regarding the following certificates where applicable: Fire Inspection (Mo./Day/Yr.)Health Inspection (Mo./Day/Yr.) Sewerage Plant Inspection (Mo./Day/Yr.)Ventilation HVAC (Mo./Day/Yr.)       PAGE \* MERGEFORMAT 4 | Alternative Education Application F M N O U ^ _  ӹ}qeVGV8hh415B*CJphhh5B*CJphhh5B*CJphh5B*CJphh415B*CJphh5B*CJphhM75B*CJphhh5IB*CJphhB*CJphh5Ih5IB*CJphh5I5B*CJphh5B*CJaJph h5Ihq5B*CJaJphh5B*CJaJphjh4jUmHnHu)N O _ ! " F rmd gdRgd5I & FL^`Lgd & FL^`Lgd41 n^`ngdR$a$gdW7$d%d&d'd(d)fNOPQRSgd$a$gd5I$&dPa$gdq$a$gdq     ! 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