This form must be signed, and enclosed with a mailed Charter Application, by any proposed Member of a Steering Committee who is not a teacher or administrator currently employed at a Participating School or in a school system that includes one or more Participating Schools.
This form must be signed, and enclosed with a mailed School Application for a Participating School, by any Mentor selected by that Participating School who is not a teacher or administrator at that or any other Participating School or an employee of a school system that includes a Participating School.
STREET ADDRESS: ___________________________________________________________
PLACE OF EMPLOYMENT: ___________________________________________________________
I affirm that: