NEW YORK STATE EDUCATION DEPARTMENT

 

ADDENDUM TO THE PETITION TO REGISTER A NEW SCHOOL

 

District:

(NYC- if an Empowerment School please give geographic district)

 

 

Address:

 

 

Person Completing the Form:

 

Title:

 

 

Phone:

 

 

FAX:

 

 

E-mail:

 

 

New School Being Registered:

 

Date of Petition Submission:

 

 

Date of Addendum Submission (if different):

 

 

Signatures

 

 

Print

Signature

Community School District Superintendent  (NYC)

 

 

 

Superintendent of Schools (ROS)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Addendum to the Petition to Register a New School

(Shaded space is for New York State Education Department use only.)

 

 

1.  Was the school building occupied by another school or schools last year?  

 

YES

NO

 

If yes, please identify the school(s):

Please give the full name and number.

BEDS code

Accountability Status (AS)

 

 

 

 

 

 

 

 

 

2.  Is the new school the result of a school split*?    If no, skip to four.   

 

YES

NO

 

If yes, please name the school being split:

Please give the full name and number.

BEDS code

Accountability Status (AS)

 

 

 

 

 

 

*Split—The new school is being separated from a currently registered public school.

*

 

 

3. Use the corresponding rows below to identify the grades that were being served at the original and the grades that will be served at the newly configured original school as well as at the new school. 

                  

 

Original (2006-07)

 

K

 

 

1

 

2

 

3

 

4

 

5

 

6

 

7

 

8

 

9

 

10

 

11

 

12

 

Original (2007-08)

 

K

 

 

1

 

2

 

3

 

4

 

5

 

6

 

7

 

8

 

9

 

10

 

11

 

12

 

New

 

K

 

 

1

 

2

 

3

 

4

 

5

 

6

 

7

 

8

 

9

 

10

 

11

 

12

Work horizontally, circle or check each box to identify grade configuration at each site.

 

 

4. Is the new school the result of a merger* of schools?   If no, skip to six.         

 

YES

NO

 

If yes, please name the schools:

Please give the full name and number.

BEDS code

Accountability Status (AS)

 

 

 

 

 

 

 

 

 

*Merger— Two or more currently registered schools uniting to form one distinct learning environment.

 

5.  For mergers, use the corresponding rows below to identify the grades to be served at the original/merging schools and the new schools.                      

 

 

BEDS code

Merging

K

1

2

3

4

5

6

7

8

9

10

11

12

 

Merging

K

1

2

3

4

5

6

7

8

9

10

11

12

 

Merging

K

1

2

3

4

5

6

7

8

9

10

11

12

 

New

K

1

2

3

4

5

6

7

8

9

10

11

12

n/a

Work horizontally, circle or check each box to identify grade configuration at each site.

 
  1. Is the new school to be a successor to a SURR school?

 

YES

NO

 

  1. Is the new school going to replace a school that is fast tracking its Phase Out?

 

YES

NO

 

  1. Is the new school a result of a closure?

 

YES

NO

 

If yes, please identify the other school(s):

Please give the full name and number.

BEDS code

Accountability Status (AS)

 

 

 

 

 

 

 

 

 

 

9.  Will the new school share the facility with other schools?  

 

YES

NO

 

If yes, please identify the other school(s):

BEDS code

Accountability Status (AS)

 

 

 

 

 

 

 

 

 

 

 

 

10.   Please identify the schools that have most recently employed the new school’s principal,

    assistant principal, and other leadership staff and/or please attach a resume to indicate the school leaders’ employment history/schooling.

 

AS

School

Please give the full name and number.

BEDS code

Proposed title (New site)

Previous title

Dates

 

Example: 

SW High School

 

Principal

Assistant Principal

7/2003-6/2005

 

 

 

Principal