Henry Ford Academy San Antonio - HENRY FORD ACADEMY...

Application Coversheet (Please type) (/) ^3 rn rn rn ^

_ Henry Ford Academy: San Antonio_

Name of Proposed Charter School

Henry Ford Learning Institute

Name of Sponsoring Entity

5 C/5 c/5 ^ j^ O :o o ~~H C^Note: If the sponsoring entity is a 501(c)(3) nonprofit organization, the name must appear exactly as it appears in the Articles •

of Incorporation or any amendments thereto. 5 G)

The sponsoring entity is a (Check only one.}: ^ rx~]501(c)(3) nonprofit organization [_j Governmental Entity j | College or University "z

;H

Chairperson of Governing Body of Sponsoring Entity: Michael Schmidt_ G> m

CEO of Sponsoring Entity: _ Deborah Parizek_ O -<

CEO/Superintendent of Proposed Charter School: TBD_ _ 3 O

Representative Who Attended an Applicant Conference: Aaron Wilson-Ahlstrom _ Date of Conference: 12/3/2007_ m - _ CO

Applicant Mailing Address: 20900 Oakwood Boulevard. Dearborn. Michigan 48 1 24

Physical Address of Proposed Administrative Offices (if different from above):

Number of Campuses Being Requested : 1_

Physical Address of Each Proposed Campus:

318 W Houston Street. San Antonio. Texas 78207

Contact Name: Shannon Clements Contact E-mail Address: sclements(qjhfli.org

Contact Phone #: 313.982.6027 ContactFaxft 313.982.6218

Circle Grade Levels to be served and state maximum enrollment for each year: By Year 3, at least one grade in which the state accountability tests are administered must be offered.

Yearl:Pre-K3 Pre-K.4 K 1 23 45 67 8(9 10 11 12 Maximum Enrollment: 120

Year2:Pre-K3 Pre-K4 K 1 23 45 67 8 9 \\9 11 12 Maximum Enrollment: 240

Year3:Pre-K3 Pre-K4 K. 1 2 3 4 5 6 7 8 9 i d u i 12 Maximum Enrollment: 360

Year4:Pre-K3 Pre-K4 K 1 23 45 67 8 ( 9 [ I d ( l l 12 Maximum Enrollment: 480

Year5:Pre-K3 Pre-K4 K 1 2 3 4 5 6 7 8 f 9 [1(1(11 (13 Maximum Enrollment: 480

I certify that I have the authority to submit this application and that all information contained herein is complete and accurate, realizing that any misrepresentation could result in disqualification from the application process or revocation after award. In accordance with TEC §12.120,1 further certify that no members of the governing body of the sponsoring entity or of the proposed charter school nor anyofficers or employees of the proposed school have been convicted of a misdemeanor involving^moral turpitude or of any felony. I understand that incomplete applications will not be considered.

.,__ Deborah Parizek (BLUEflNJQ Signature of/Chief Executive Officer of Sponsoring Entity Date,Mvviq »lv' ^(IÔT^Sî

/ A ' /t2s^7&~ -7 JiJ^ - ! : ^ - - b i^nr-on iÂAA^ (r~A /?

new address for Henry Ford Academy: Alameda School for Art + Design Page 1 of 1

Salvo, Rick ' ~ " APPROVED DURING CONTINGENCY PROCESS From: Shannon Clements [[email protected]]

Sent: Tuesday, June 23, 2009 11:46 AM

To: Salvo, Rick

Subject: new address for Henry Ford Academy: Alameda School for Art + Design

Hello Rick — it was great to talk with you this morning.

The new address of record for the Henry Ford Academy is 429 Arbor Place, San Antonio, TX, 78207.

We will begin occupying/working in the building on August 3, 2009, at which time mail delivery will begin. Is there a way to ensure that any written/mailed correspondence is delivered at the 381 W. Houston address until that time?

Thank you for your help.

-Shannon A. Clements

6/29/2009

APPROVED DURING

Anderson, Valerie_ CONTINGENCY PROCESS _

From: Jeffrey D. Flores [[email protected]] Sent: Wednesday, July 22, 2009 1 1:51 AM To: Anderson, Valerie Subject: Re: AskTED changes for HFA: Alameda School for Art + Design

Yes, our official name is; [Henry Ford Academy; Alameda School for Art + DesignA School starts August 26th. l J

On another note, who can I talk to about my TEASE access? I applied Monday and am waiting for access.

Thanks for everything.

Henry Ford Academy: Alameda School for Art + Design 210-527-9000 (Office) 210-426-6645 (Cell) j f lores@thealamedaschool . org

----- Original Message ----From: "Valerie Anderson" To: "Jeffrey D. Flores" < jf lores@thealamedaschool . org> Sent: Wednesday, July 22, 2009 11:43:08 AM GMT -06:00 US/Canada Central Subject: RE: AskTED changes for HFA: Alameda School for Art + Design

Mr. Flores,

I updated your email, fax number and web address. Do you have an actual start date for the school? Also we have your school name as Henry Ford Academy San Antonio is this correct? I see you are referring to the Alameda School for Art + Design should that be how you are listed in AskTED?

Thank you,

Valerie Anderson 512-463-9575

----- Original Message ----From: Jeffrey D. Flores [mailto: j f lores @thealamedaschool .org] Sent: Wednesday, July 22, 2009 11:28 AM To: Anderson, Valerie Subject: AskTED changes for HFA: Alameda School for Art + Design

Valerie,

Can you make the following changes to our AskTED info?

My email to [email protected] Fax number: 210-527-9053 Web address: www. thealamedaschool . org

Thanks, . ,̂ (® 3(

Henry Ford Academy: Alameda School for Art + Design 210-527-9000 (Office) 210-426-6645 (Cell) j f lores@thealamedaschool . org

mailto:[email protected]:[email protected]

REVISED DURING CONTINGENCY PROCESS SEE INSERT.

Table of Contents

Application Sections Section 1 : Statement of Need 4 Section 2: Vision of the School 10 Section 3 : Education Plan 14 Section 4: Student Goals 30 Section 5: Human Resources Information 32 Section 6: Governance 60 Section 7: Community Support 73 Section 8: Geographic Boundary 77 Section 9: Admissions & Enrollment Policies 79 Section 10: Special Needs Students & Programs 83 Section 1 1 : Business Plan 84

Attachments Attachment A - Notarized Biographical Affidavits 93 Attachment B- Organizational Chart of the Sponsoring Entity 138 Attachment C - 501(c)(3) Determination Letter from the IRS 140 Attachment D - Articles of Incorporation 145 Attachment E - Bylaws 160 Attachment F- Published Notice of Public Hearing 220 Attachment G- Synopsis of Public Hearing 222 Attachment H - Signed Certified Mail Receipt Cards 226 Attachment I - Audit Report 238 Attachment J - Credit Report 250 Attachment K - IRS 990 Filing 253 Attachment L - Documentation Verifying All Sources of Funding 295 Attachment M - Start-Up Budget 298 Attachment N - Budget for First Three Years of Operation 309 Attachment O - Negotiated Service Agreements 358 Attachment P - Negotiated Lease Agreements (Letter of Intent to Lease) 377

^Exhibits Exhib1t4 - HFLI Advisory Jfoapl \ 381 Exhibit 2^sQ)llege and Career Re&djness Report Cards ^\^ 383 Exhibit 3 - Tinteline to Adapt 9th Grade^C^re Curriculum to HFXs§an Antonio 394 Exhibit 4- Senior Ntestejy Process Assessm&rW^Rubrics ^\ 396

Page 2

Henry Ford Learning Institute Charter Schools Contingency Issues for Resolution

Area: Other Remove from the application all exhibits after Attachment P.

HFLI agrees that the Texas Education Agency may remove all exhibits after Attachment P from its application.

APPROVED DURING CONTINGENCY PROCESS

Contact: Shannon A. Clements 18 1/23/09 [email protected]

mailto:[email protected]

Applicant Checklist

Henry Ford Academy: San Antonio Henry Ford Learning Institute Proposed Fourteenth Generation Charter School Name Sponsoring Entity Name This checklist MUST be completed and submitted as part of the application to ensure that the applicant has provided all of the information required by the RFA.

Application S" Attended Applicant Conference: Date 12/3/07 : Board Member Who Attended Aaron Wilson-Ahlstrom B; Application Coversheet B Table of Contents Jg Applicant Checklist (this document) Application Sections (Alt questions in each section must be answered completely.) H 1 Statement of Need H 6 Governance BI 2 Vision of the School jjg 7 Community Support H, 3 Educational Plan IS 8 Geographic Boundary IS 4 Student Goals Kl 9 Admissions Policy S 5 Human Resources Information 0 10 Special Needs Students and Programs Attachments A - P 12 11 Business Plan

gl A Notarized Biographical Affidavits for members of the governing body of the sponsoring entity or of the charter school (if any) and any identified officers of the charter school

H B Organizational Chart reflecting all of the sponsory entity's operations, including the proposed charter school 63 C 501(c)(3) Determination Letter from IRS or statement that it is not required if sponsoring entity is an

institution of higher education or a governmental entity gp D Articles of Incorporation filed with Texas Secretary of State or a comparable document if the sponsoring

entity is an out-of-state nonprofit corporation or a statement that this not required if the sponsoring entity is an institution of higher education or a governmental entity. (If the sponsoring entity has amended its Articles of Incorporation, it must submit both the original Articles of Incorporation and the documents reflecting amendments to the original Articles of Incorporation. The failure to submit all of these documents will render this attachment incomplete.) If incorporated after January 1, 2006, substitute with Certificate of Formation and Certificate of Filing

H E Corporate Bylaws or statement that it is not required if sponsoring entity is an institution of higher education or a governmental entity

H F Published Notice of Public Hearing showing name of the newspaper and date of publication and stating the proposed school name, sponsoring entity name, date, time, and place of meeting, and names of sponsoring entity board members

H G Synopsis of Public Hearing H H Signed Certified Mail Receipt Cards showing that relevant school districts and charter schools received

statement of impact forms (In the absence of signed certified mail return receipt cards, the certified mail receipt showing each addressee, fees paid, and the date mailed will be accepted.)

H I Audit Report or one of the following: (I) unaudited fincial statements (consisting of an unaudited statement of financial position; an unaudited statement of activities; and an unaudited statement of cash flows including a notarized acknowledgement signed bv the chief executive officer and chief financial officer of the sponsoring entity attesting to the accuracy and completeness of the information provided) or (2) a statement that no documents arc being provided because the sponsoring entity was incorporated after January 1, 2006 and has less than $5,000 in receipts and total assets.

H J Credit Report or a statement that no report is provided because the sponsoring entity was incorporated after January 1, 2006 and has less than $5,000 in receipts and total assets.

IS K IRS 990 Filing or a statement explaining why it is not available. S L Documentation Verifying All Sources of Funding or a statement explaining that there are no sources of

funds (General letters of support should NOT be included). S M Start-Up Budget S N Budget for Year One of Operation (Budgets for Years Two and Three arc required in some cases where

escalating enrollment is planned.) S O Negotiated Service Agreement(s) or a statement explaining why no agreements are being provided. IS P Negotiated Lease Agreement(s), Deed(s) to Property, Earnest Money Contract(s), or Purchase

Agreement(s) or a statement explaining why no documents are being provided 0 12 Attachments (Mark here to indicate that all attachments have been included in the order required.)

Christopher ReynoldsName, o£Application Preparer (Typed)

. Deborah Parizek Name of CEO of Sponsoring Entity (Typed)

Signature of Application Preparer

18

Date

Page 3

SignatuTe"of CEO of Sponsoring Entity Date

SAS 529-08 RFA 70 1-07-1 16

COPYRIGHT MATERIAL

14 pages have been withheld

PLEASE NOTE: The responsive information contains copyrighted information that can only be made available to you for viewing in person. Because the

information indicates that it is protected by copyright, you may review this information in person during normal business hours at TEA. If you are

interested in reviewing the copyrighted information, please send an email to [email protected] to schedule an appointment.

mailto:[email protected]�

, . . ..f . APPROVED DURING CONTINGENCY PROCESS Henry c Ford Learning ¥ Institute Charter Schools Contingency Issues for Resolutio.

Area: Education Plan p. 18 and p. 21 - please replace current text on these pages with text below (highlights indicate changes/additions as requested)

p. 18 Special Education. HFA: San Antonio will comply with all federal and Texas state regulations and policies related to Special Education. HFA: San Antonio understands that placement for Special Education students is determined by the ARD committee and that placement in the mainstream is not predetermined.

p. 21 Special Education. Teaching through projects provides opportunities for students with different learning styles the ability to master relevant TEKS through areas of strength, while supporting their work on weaker areas. Because the tasks are varied and complex, differentiated instruction occurs naturally, another benefit for Special Education students. And, because the instruction is differentiated for everyone in these kinds of projects, students with learning disabilities are able to get the support and accommodations they need without the stigma often attached to receiving "special accommodations." HFA: San Antonio understands that placement for Special Education students is determined by the ARD committee and that placement in the mainstream is not predetermined.



COPYRIGHT MATERIAL








Area: Teacher to Student Ratio -- please replace current text on p. 24 with the text below. Highlights indicated added/edited text as requested.

p. 24 3d) Each grade level will be composed of five cohorts of approximately twenty-four (24) students each, for a total of 120 students at each grade level. Overall, this structure creates an average teacher-student ratio of 1:24 in class settings. The overall teacher-to-student ratio will be lower (1:18 or better) because there will be 7-8 instructional staff foi the 120 students. HFA: San Antonio will ensure that no more than 28 students will be placed in any one class.

Contact: Shannon A. Clements 2 1/23/09 sha nnp ncj@ thehenryford.org

http:thehenryford.org

COPYRIGHT MATERIAL






„ . _ . ¥ . APPROVED DURING CONTINGENCY PROCESS Henry Ford Learning Institute Charter Schools Contingency Issues for Resolution

Area: Student Goals - please replace current text on p. 31 with the text below. Highlights indicated added/edited text as requested.

p. 31 Goal 5:100% of graduates will be admitted to college or other post-secondary education/training programs. As Henry Ford Academy students progress through high school, they complete predetermined and necessary steps to prepare themselves for college, and that progress is monitored through the College and Career Readiness Report Cards described above. During their 12th grade year, all students will be required to complete and submit an application to at least three colleges or appropriate post-secondary education/training programs: the goal for each graduate will be acceptance to at least one post-secondary program.. The school will provide support for all students in this process, including financial support for application fees as needed. The school counselor will record data for all students regarding which schools/programs they apply to, and whether or not they were accepted. This data, along with a total number of scholarship dollars awarded to students, will be included in an annual report produced by the school, both for internal and external review.

Contact: Shannon A. Clements 3 1/23/09 s han none (5)th eh en rvfbrd.org

http:rvfbrd.org

COPYRIGHT MATERIAL






Henry Ford Learning Institute APPROVED DURING CONTINGENCY PROCESS Charter Schools Contingency Issues for Resolut

Area; Human Resources Information - please insert the following text p. 32 Planning Director

POSITION DESCRIPTION: PLANNING DIRECTOR

TITLE: Planning Director SCHOOL: San Antonio REPORTS TO: Principal

SUMMARY OF PURPOSE The Planning Manager must be a dynamic, dedicated and energetic individual responsible for assisting the Director in the planning process for the new Henry Ford Academy: San Antonio high school to be developed and opening in August of 2009, The Manager will report to the Director and will work closely with The Alameda, Henry Ford Learning Institute (HFLI), other local school partners and the founding staff of HFA: SA to ensure an effective planning and outreach process.

ESSENTIAL FUNCTIONS

• Facilitate the planning process for the new school to open in August 2009, including scheduling on-site and phone meetings, developing agendas and follow-up plans,

• Monitor progress on and update the HFLI school start-up checklist, • Facilitate the work to inform the community about and build support for the new school,

including scheduling and managing logistics for information and student recruitment sessions and other public meetings, and attending/presenting at these meetings,

• Work with community organizations, including church and religious organizations, business organizations, other public and private schools, and other non-profit and community-based organizations to inform them of the school and build support for it,

• Assist in the preparation of materials that provide information about the school, including Power Point presentations, posters, flyers and other printed materials and a school web site,

• Track additional collaborative opportunities that might support student internships, enhance student academic programs during the school day, after school and on Saturdays, and support teachers in classroom enhancement activities once the school opens,

• Develop and manage a system to track community engagement activities and participation, • Record and document effective methods of community and family engagements lessons

learned to be incorporated into HFLI school start-up toolkit for other Henry Ford Academies;

• Provide input to Director for regular updates on progress to HFA: SA's Board of Directors, and

• Other duties as assigned.

MINIMUM REQUIREMENTS: Bachelor's degree required; advanced degree preferred. Candidate must be passionate about furthering education reform in a public environment Belief that all students, regardless of race, socio-economic status, family background or past academic performance can succeed. Experience in managing broad, complex projects with multiple partners, community engagement, education, nonprofit and/or education fields in San Antonio. Highly organized; capable of handling numerous projects simultaneously and able to prioritize, with keen attention to detail; work collaboratively with others involved in fundraising, program and proposal development



APPROVED DURING CONTINGENCY PROCESS Henry Ford Learning Institute Charter Schools Contingency Issues for Resolution

SPECIAL SKILLS: Exhibit integrity beyond reproach and build trusting relationships within and outside HFLI, local partners and national partners. Able to work with teachers, students, parents, volunteers, and Board members effectively. Facility in the use of Microsoft Office. Able to strategize, plan, execute and interact with tact, discretion and diplomacy. Ability to respond to requests [email and phone) quickly and effectively. Able to function within a team environment with minimal clerical/secretarial support. Flexibility in work location (Dearborn, Detroit).

PREFERRED SKILLS: Specific experience with charter schools and/or small school models. Specific experience and excellent reputation for program development and implementation in San Antonio.




Area: Human Resources Information - please insert the following information, p. 44 Special Education Coordinator

POSITION DESCRIPTION: Special Education Coordinator

TITLE: Special Education Coordinator SCHOOL: Henry Ford Academy: San Antonio REPORTS TO: Instructional Team Leader

SUMMARY OF PURPOSE:

The Special Education Coordinator is responsible for identifying children with special needs and/or learning disabilities, working with students with disabilities individually, in groups, or within their classroom, working with teachers to identify best practices for differentiated instruction, and designing and implementing Individual Education Plans for students. In addition, the Special Education Coordinator shall collect, review, update and securely store student files; and convene IEP/IEPT meetings and annual reviews.

ESSENTIAL FUNCTIONS Student Achievement

• Plan a program of study that meets the individual needs, interests, and abilities of the students

• Assist in establishing curricular objectives and the development of the comprehensive plan for the implementation and evaluation of the objectives

• Implement differentiated curriculum that is aligned with state standards and school goals

• Focus staff on student performance through the monitoring of teacher grade books and data for special needs students

• Assist teachers with the creation and implementation of differentiated instruction for students who are struggling

• Ensure that teachers set clear, measurable, attainable and rigorous performance goals for their individual students and classes as a whole

• Plan and co-teach with individual teachers as needed

Teacher/Staff Development and Accountability • Write and review reports according to the law and submit all documentation

required by HFA: SA and State of Texas and federal agencies and departments • Meet deadlines for submitting required documentation • Assist teachers with the implementation of school curriculum • In collaboration with administration, participate in the training of new staff around

special education laws • Lead in the design and advertisement of professional development opportunities for

the whole staff and individual staff members • Attend leadership meetings and provide guidance on special education related

issues • When necessary, provide one-on-one coaching to teachers so that their students can

achieve high standards • Keep up to date with current educational research on curriculum and instruction • Manage all aspects of student database relative to Special Education

Contact: Shannon A. Clements 7 1/23/09 shannonc@t:hehencvJorcLpre



Operations and Compliance • Coordination and administration of standardized testing materials • Initiate the requisition of appropriate curricular materials for the school • Assist in the management of student database, school records and school reports • Keep up with changes that are made to the State of Texas and federal educational

standards • Facilitate all manifestation hearings

School Environment • Promote high academic standards for all students • Together with HFA: SA staff, plan and facilitate Forum activities/curriculum • Maintain a high level of professionalism and promote the same level of

professionalism for other staff members • Create an open line of communication with the faculty/staff to promote a positive,

collegial atmosphere • Serve as a model for the staff for effective student discipline by personally

demonstrating the persistence, insistence, and consistence necessary to inspire positive behavior

Parent and Community Relations • Monitor staff communication with parents i.e. phone calls, letters, mailings, etc. • Assist administration in promoting the participation of students, parents and staff in

school initiated activities • Communicate with parents frequently about the progress and needs of students

Leadership • Effectively communicate the mission of HFA: SA to students, staff, parents and

community members • Provide mentoring for new and current staff • Work with the leadership team to problem solve all major areas of school concern • Assist administration with projects as requested • Supervise breakfast and lunch as needed • Meet all obligations as set out in the HFA Staff Handbook

QUALIFICATIONS: Bachelor's degree or higher. Valid Texas teacher certification with Special Education endorsement. Experience working with students with various learning disabilities and special needs. Experience working with students who have been educationally underserved. Commitment to the mission of HFA: SA.

MINIMUM REQUIREMENTS: Bachelor's degree and Special Education Certification required Experience in education, target academic content area certification and teacher leadership are critical. This position requires substantial expertise in urban education, includinga proven record of effective authentic instruction, significant work with families and students as partners in learning, and integration of a wide range of unique, community resources. An evident commitment to holding all students to high expectations for academic and personal success is also a must

SPECIAL SKILLS: Experience in secondary schools that face instructional and material challenges is critical as is significant expertise in working with urban families, developing community




partnerships and collaborative decision-making and leadership. Candidates should be comfortable operating in a flexible, self-directed and fast-paced work environment. Experience in an entrepreneurial educational environment is highly desired.

PHYSICAL/MENTAL/ENVIRONMENT: Physical: Sitting: 30%

Standing/walking: 70%

Lifting: Not significant

Vision: Able to work on desktop and laptop computers, and read written material

Mental: Able to handle various instructional challenges and projects and work with a variety of other people in a collaborative manner

Environment: Highly visible classroom with wide range of people present will require flexibility, patience, creative use of shared space; personal workstation for responsibilities outside of direct interactions with students; regular short term travel to local community organizations and institutions.





Area: Human Resources Information - please insert the following information

Provide job descriptions for the following positions listed on the organizational chart: office manager, counselor, community outreach, security and social worker.

POSITION DESCRIPTION: OFFICE MANAGER

TITLE: Office Manager SCHOOL: Henry Ford Academy: San Antonio REPORTS TO: Director of Finance & Operations/PEIMS Coordinator

SUMMARY OF PURPOSE Office Manager shall perform all duties as assigned by the Henry Ford Academy, adhere to all Academy policies and procedures as may be in effect at any time during Office Manager's employment, and comply with all requirements of Texas, federal and other applicable law with respect to the Academy's operations and/or Office Manager's performance of his/her duties. Office Manager's duties shall include, but shall not be limited to the following essential functions:

ESSENTIAL FUNCTIONS

• Report to Principal or his or her designee. • Assist Principal and Assistant Principal with administrative and clerical duties • Organize meetings, conferences, and Academy visitations • Maintain all pertinent Academy records • Prepare bookkeeping and financial records in conjunction with Director of Operations • Manage and record all correspondence between Academy and other entities • Act as a liaison between Museum personnel and Academy for all daily activities • Provide support services to the Board of Directors as necessary • Maintain a positive relationship with all external audiences • Attend all Academy Board of Directors meetings as necessary • Recruit and assign substitute teachers as needed • Prepare monthly school calendars • Order office and school supplies • Recruit, coordinate, and supervise office volunteer staff • Maintain school-wide mailings • Coordinate/Facilitate needs of instructional staff • Provide all other administrative and/or clerical duties subsequently determined by

Principal to facilitate the mission, goals and standards of the Academy. • Acts as a team player and provides expertise within the team and with other teams as

appropriate

MINIMUM REQUIREMENTS: Two-year or four-year degree in business administration preferred, and/or equivalent experience. Excellent skills in Microsoft Word, Excel, Access and Outlook, including merges, spreadsheets, etc. Ability to proofread correspondence. Excellent verbal and written communication skills. Proficiency in Spanish and English.

SPECIAL SKILLS: Experience in a school setting with students and parents from diverse backgrounds. Proven organizational and problem-solving skills; excellent interpersonal skills; keen attention to detail.

PHYSICAL/MENTAL/ENVIRONMENTAL Physical: Sitting: 85%

Contact: Shannon A. Clements 10 1/23/09 shannonct5>thehenrvfojd.org

http:shannonct5>thehenrvfojd.org


Standing: 15% Lifting: 10 Ibs.

Vision: Able to use computer 4-6 hours/day.

Mental: Self-motivated, multi-tasking ability; able to stay focused in a distracting, noisy environment; ability to work with people in a positive manner; able to keep sensitive information confidential; and able to respond effectively and maintain a calm environment in emergencies

Environment: Very active high school office.

POSITION DESCRIPTION: COUNSELOR

TITLE: Counselor SCHOOL: Henry Ford Academy: San Antonio REPORTS TO: Director of Finance & Operations/PEIMS Coordinator

SUMMARY OF PURPOSE: The Henry Ford Academy: San Antonio Counselor will provide a comprehensive guidance program that meets the needs of all 9-12 students. Counselor will promote and enhance academic, personal, social, and career development of the students.

ESSENTIAL FUNCTIONS

• Implement a comprehensive guidance program which meets the needs of students in grades 9-12

• Promote and enhance academic, personal, social, and career development of the students • Conduct structured, goal-oriented counseling sessions in response to identified needs of

individuals and groups of students • Consult with and serve as a resource for teachers, staff, and parents regarding the

developmental needs of students • Refer students and their parents to community agencies, programs, or specialists as

appropriate • Participate in the evaluation and revision of the school guidance program • Fulfill professional responsibilities • Assist in school scheduling and programming, and other logistical functions as needed • As a member of the Administrative Team, fulfill before and after school responsibilities • Conduct before and after school meetings and presentations for parents, students and

community • Assist in the recruitment of new students • Other general counseling and administrative functions as needed

MINIMUM REQUIREMENTS: Bachelor's degree and counseling certification; experience with college and career preparation ideal. This position requires substantial expertise in urban education, including significant work with families and students as partners in learning, and integration of a wide range of unique, community resources. Candidate should exhibit integrity beyond reproach and be passionate about furthering educational reform in a public environment. A commitment to holding all students to high expectations for academic and personal success is also a




must. Candidate should have superior written and oral communication skills; ideal candidates have experience coordinating extra-curricular events and activities and capacity to work collaborativery across disciplines. Proficiency in Spanish and English.

SPECIAL SKILLS: Start up experience in a charter school environment is critical as is significant expertise in the areas of educational reform, community partnership development, and collaborative decision-making and leadership. Candidates should be comfortable operating in a flexible, self-directed and fast-paced work environment with limited administrative support. Experience in an entrepreneurial educational environment is highly desired.

PHYSICAL/MENTAL/ENVIRONMENT: Physical: Sitting: 30%


Lifting; Not significant


Mental: Able to handle various projects with deadlines and work with a variety of other people

Environment: Highly visible school with wide range of people present will require flexibility, patience, creative use of shared space; personal workstation for responsibilities; regular short term travel to local community organizations and institutions.

PQSTION DESCRIPTION: Community and Family Engagement Director (Community Outreach)

TITLE: Community and Family Engagement Director (Community Outreach) SCHOOL: Henry Ford Academy: San Antonio REPORTS TO: Principal

SUMMARY OF PURPOSE The Community and Family Engagement Director will be a dynamic, dedicated and energetic individual responsible for directing the local community and family engagement and planning process for the new Henry Ford Academy charter high school to be developed in San Antonio. The Director will work closely with community members and local partners, the Henry Ford Learning Institute (HFLI) senior staff, local school partners and the founding staff of HFA: San Antonio (founding principal, teacher and director of operations) to ensure a collaborative, effective and inclusive outreach process.

ESSENTIAL FUNCTIONS

• Work with community volunteers, partnership staff, the founding staff, HFLI and board members (the "planning team") to facilitate a collaborative and inclusive community outreach process;

• Facilitatethe input and work of local partners and community members to inform the community about and build support for the new school, including intensive information and student recruitment sessions;

Contact: Shannon A. Clements 12 1/23/09 shannoncfo) thehenrvforri.org

http:thehenrvforri.org


• Work with community organizations, including church and religious organizations, business organizations, other public and private schools, and other non-profit and community-based organizations to inform them of the school and build support for it,

» Develop and implement a variety of community outreach and information sessions, including small group discussions, student/family informational and recruiting meetings, and larger community-wide meetings,

• Develop in collaboration with the planning team a student and parent orientation program to be implemented in the months prior to the school's opening,

• Prepare materials in collaboration with the planning team and contractors to distribute at these sessions, including power point presentations, posters, flyers and other printed materials as needed,

• Identify and pursue collaborative opportunities, including other schools and business, higher education, community and non-profit organizations, to support student internships, enhance student academic programs during the school day, after school and on Saturdays, and to support teachers in classroom enhancement activities;

• Gather input from the local community regarding planning and start-up issues, communicate back to the planning team, and implement changes to improve the process;

• Provide comprehensive support to the planning team implementing the new Henry Ford Academy to prepare for an August 2009 opening, including:

o Community outreach, o Student recruitment, o Grant applications and other donations, and o Local media and PR efforts.

• Develop and manage a system to track community and family engagement activities and participation.

• Provide regular updates on progress to Board of Directors; • Record and document effective methods of community and family engagements lessons learned

to be incorporated into HFLI school start-up toolkit for other Henry Ford Academies; • Other duties as assigned.

MINIMUM REQUIREMENTS: Bachelor's degree required; advanced degree preferred (e.g. MSW, Urban Planning, and other advanced degrees). Experience in community and family engagement and involvement, community schools, education, nonprofit and/or education fields in San Antonio. Highly organized, self-motivated, exemplary public speaking, written and conceptual skills; capable of handling numerous projects simultaneously and able to prioritize, with keen attention to detail; work collaboratively with others involved in fundraising, program and proposal development. Candidate must be passionate about furthering education reform in a public environment.

Ability to travel and spend two to four days per month in Dearborn, Michigan for initial and ongoing training at HFA-Dearborn and with HFLI staff.

SPECIAL SKILLS: Hands-on entrepreneurial experience. Specific experience with charter schools and/or small school models. Specific experience and excellent reputation for program development and implementation in San Antonio. Belief that all students, regardless of race, socio-economic status, family background or past academic performance can succeed academically.

Exhibit integrity beyond reproach and build trusting relationships within and outside HFLI, local partners and national partners. Ability to work with teachers, students, parents, volunteers, and Board members effectively. Facility in the use of Microsoft Word, Excel, Power Point, and Outlook. Able to strategize, plan, execute and interact with tact, discretion and diplomacy. Able to function effectively within a team




environment with minimal clerical/secretarial support. Able to work in an exemplary manner with minimal supervision.

PHYSICAL/MENTAL/ENVIRONMENTAL

Sitting: 80% Standing: 20%

Some boxes weighing between 10-20 Ibs

Normal. Able to work with desktop/lap top computers.

Desire to succeed; desire to continually improve performance; goal-achievement oriented; willing to work hard and occasionally put in long hours; able to collaborate effectively; flexibility and creativity in approach to organizational start-up challenges and team work.

Environmental: Fast-paced collaborative start-up school environment.

POSITION DESCRIPTION: Security/Police Officer

TITLE: Security/Police Officer SCHOOL: Henry Ford Academy: San Antonio REPORTS TO: Principal

SUMMARY OF PURPOSE:

The purpose of the Security/Police Officer is to demonstrate a commitment to the education of our youth and to maintain an appropriate learning environment through the protection of students, employees and property.

ESSENTIAL FUNCTIONS

• Perform all duties as outlined in district and department policies, rules, and procedures • Respond to all calls requiring peace officer intervention or service, and initiate activity

where needed to ensure a safe and secure environment • Work any hours, shifts, days, or assignments given • Enforce laws, policies and provisions of the Texas Penal Code, and Code of Criminal

Procedure Texas Education Code and Henry Ford Academy: San Antonio policy manual and code of conduct

• Prepare appropriate police reports; identify and report potential safety and security hazards, conduct initial investigations, and act on community and school concerns

• Serve as an appropriate, positive role mode for students • Perform special duty assignments, overtime, protective details and all other duties as

assigned or required • Perform all physical demands and job tasks required of police officers

MINIMUM REQUIREMENTS: Certification as a Peace Officer by the Texas Commission on Law Enforcement Standards and Education (TCLEOSE). High school graduate (preferred) or GED certificate. Minimum of two years recent law enforcement experience or 60 college hours and/or recent completion

Contact. Shannon A. Clements 14 1/23/09 shannoncto) thehenrvfQrd.org

http:thehenrvfQrd.org


of the Basic Peace Officer Training School. A valid Texas driver's license and good driving record. Meet and maintain liability coverage and eligibility.

SPECIAL SKILLS: Demonstrated knowledge of laws, rules, and regulations applicable to the position. The ability to work with others. Demonstrated communication skills, credibility and demeanor appropriate to the position. Demonstrate logical, effective problem-solving ability. Successfully pass the entire screening process. Ability to work all shifts, holidays and weekends, and a variety of assignments as directed.

PHYSICAL/MENTAL/ENVIRONMENTAL

Physical: Sitting: 20% Standing: 80%

Lifting: Moderate: some boxes weighing between 15-44 Ibs

Vision/Hearing: Significant hearing and reflexes are necessary, near vision, far vision, peripheral vision, color discrimination, depth perception

Mental: Maintain emotional control under stress. Work well with frequent interruptions. Ability to work well with others in close proximity and while under stress.

Environmental: Fast-paced collaborative start-up school environment.

POSITION DESCRIPTION: SOCIAL WORKER

TITLE: Social Worker SCHOOL: Henry Ford Academy: San Antonio REPORTS TO: Instructional Team Leader

SUMMARY OF PURPOSE: The Henry Ford Academy: San Antonio Social Worker will provide a link between home, school, and community. Social Worker will facilitate students and their families in overcoming social and personal problems, provide individual and group counseling and consult with teachers and other services which help students cope with their disabilities. Must collaborate with community agencies and provide case management for students and families requiring multiple services.

ESSENTIAL FUNCTIONS • Meet formally and informally with students, family members, and school personnel to

gather information required about a student's social, emotional, and behavioral adjustment to school and the community

• Assist students, teachers, and parents to develop solutions to family and community factors that inhibit a student's capacity or ability to learn

• Collaborate with education and social services professionals to develop appropriate agency services for students and their families

• Collaborate with various school groups to develop coping, social, and decision making skills • Perform Social Work and Counseling functions as needed.

Contact: Shannon A Clements 15 1/23/09 s ha n none® the henrvfo rd.org


MINIMUM REQUIREMENTS: Texas School Social Work Certification and corresponding degree (usually M.S.W.). This position requires substantial expertise in urban education, including significant work with families and students as partners in learning, and integration of a wide range of unique, community resources. Candidate should exhibit integrity beyond reproach and be passionate about furthering educational reform in a public environment. A commitment to holding all students to high expectations for academic and personal success is also a must. Proficiency in Spanish and English.

SPECIAL SKILLS: Start-up experience in a charter school environment is critical as is significant expertise in the areas of educational reform, community partnership development, and collaborative decision-making and leadership. Candidates should be comfortable operating in a flexible, self-directed and fast-paced work environment with limited administrative support. Experience in an entrepreneurial educational environment is highly desired. PHYSICAL/MENTAL/ENVIRONMENT: Physical: Sitting: 30%


Lifting: Not significant


Mental: Able to handle various projects with deadlines and work with a variety of other people

Environment: Highly visible school with wide range of people present will require flexibility, patience, creative use of shared space; personal workstation for responsibilities; regular short term travel to local community organizations and institutions.



COPYRIGHT MATERIAL








Area: Human Resources Information - please insert the following information.

p. 58 Provide an analysis of salary and benefits for the REIMS Coordinator, Office Manager/Financial Assistant and Counselor.

5n) The salary of the DFO / PEIMS will he comparable to salaries offered at schools in proximity to

HFA: San Antonio, with an anticipated range in salary of $50,000 - $75,000 for this position. Part of the DFO / PEIMS Coordinator's compensation will likely include performance based components. A comprehensive benefits package will be offered, including medical, dental, employee assistance programs, and other benefits. The school will also offer a 401(k) or 403(b) retirement plan for its employees.

The salary of the Office Manager will most likely be between $25,000 and $35,000, based on experience. Based on research at schools in San Antonio, including KIPP: Aspire (which has an Administrative Assistant at $35,000/year) and with other local non-profits, including the CEO Foundation which had a bilingual, full-time office manager at $25,000/year, this salary seems well in-line with local salaries and will allow the school to hire a qualified. A comprehensive benefits package will be offered, including medical, dental, employee assistance programs, and other benefits. The school will also offer a 401(k) or 403(b) retirement plan for its employees.

The salary of the counselor will most likely be between $45,000 and $50,000. Based on research of salaries at local districts (SAISD counselor position of 220 days at $49,673/year and NorthEast ISD counselor position of $52,000 to $64,774 full-time), we expect to offer a competitive salary to attract and retain highly qualified staff. A comprehensive benefits package will be offered, including medical, dental, employee assistance programs, and other benefits. The school will also offer a 401(k) or 403(b) retirement plan for its employees.



COPYRIGHT MATERIAL






Attachment A- Notarized Biographical Affidavits

Piige 93

Fourteenth Generation Open-Enrollment Charter School Applicant Biographical Affidavit (MUST BE TYPED and NOTARIZED)

Check all that apply:

[*] Member of the governing body of the sponsoring entity

1 I Member of the governing body of the charter school

I I School officer; State position as defined in TEC, §12.1012

Full Name of Sponsoring Entity Henry Ford Learning Institute (HFLI)

Full Name of Proposed Charter School Henry Ford Academy; San Antonio (HFA: SA)

In connection with the above-named organization and charter school application, I herewith make representations and supply information about myself as hereinafter set forth. (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully.)

IF ANSWER IS "NO" OR "NONE", SO STATE.

1. Full Name (Initials Not Acceptable) Michael Thomas Schmidt

2. Have you ever had your name changed or used another name? JGI Yes &3 No

If yes, give reason for the change:

Maiden name (if female):

Other names used at any time: Mike Schmidt

3. Current home address: 13100 Ludlow Ave., Huntington Woods MI 48070

If you are a member of the governing body of the sponsoring entity and the sponsoring entity is an out-of-state organization, do you reside within 50 miles of the geographic boundary of the proposed charter school?

£3 Yes ^ No £3 N/A (because I am not a member of the governing body of the sponsoring entity or the sponsoring entity is based in Texas).

4. Current home telephone number: 248-398-8017

5. Education: Dates, Names, Locations and Degrees

College: University of Michigan (Ann Arbor), Bachelor of Arts: Political Science and History, May 1989

„ , „ ,. University of Maryland School of Public Affairsv (College Park), Masters of Public Mgmt,a May 1991 3 J 6 JGraduate Studies: '

Others:

6. List membership(s) in professional societies and associations:

Council on Labor & Economic Growth - Appointed by Governor (MI) 2006 - 2009 Partnership for 21st Century Skills - Board Member since 2005; Board Treasurer 2006-07 Michigan Business Leaders for Excellence in Education - Member since 1998

UrnmHatinn fr.r PHiif atJnn T PaHfrchir* _ TtnarH MprnKgr 1 QQR

SAS 529-07 RFA 701-06-021

7. List complete employment record, including self-employment (up to and including present jobs, positions, directorates or officerships) for the past ten (10) years:

DATES EMPLOYER ADDRESS POSITION

Jan. 2003 - Present, Ford Motor Company Fund, Dearborn MI, Director, Education and Community Development July 1996 - Jan. 2003, Ford Motor Company, Dearborn MI, External Education Program Manager March 1993 - July 1996, Executive Office of the President - Domestic Policy Council, Washington DC, Senior Policy Analyst June 1991 - March 1993, Office of Personnel Mgmt, Washington DC, Presidential Mgmt Intern/Employee Dev. Specialist

8. List all businesses or organizations of which you are a partner or in which you have a majority interest:

n/a

9. List all previous experience with charter schools. Include open-enrollment schools and/or campus or program charters:

DATES CHARTER SCHOOL/CHARTER HOLDER ADDRESS POSITION

1995 to present, Henry Ford Academy, Dearborn MI, Board Member Since 2000 2004 to present, Henry Ford Learning Institute, Dearborn MI, Current Chairman, Board Member Since 2004

10. List all previous experience with any charter school management company:

DATES MANAGEMENT COMPANY ADDRESS POSITION

n/a

11. List any professional, occupational, or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past. (State date license was issued, issuer of license, date terminated, reasons for termination:

n/a

D i fA D nc SAS 529-07 Page2°f4 Page95 RFA 701-06-021

12. During the last ten (10) years, have you ever been refused a professional, occupational or vocational license by any public or governmental licensing agency or regulatory authority, or has such license held by you ever been suspended or revoked?

O Yes (•) No

If yes, give details:

13. Will you be employed by or contract with the sponsoring entity, the charter school, or the managment company of the school?

O Yes No If so, please state the compensation you expect to receive.

Also explain any other compensation you expect to receive for service on the governing body of the sponsoring entity.

14. Is any relative within the third degree of consanguinity (i.e., your parent, grandparent, great-granparent, child, grandchild, great-grandchild, sibling, aunt, uncle, niece, nephew) or within the third degree of affinity (i.e., your spouse or your spouse's parent, grandparent, great-granparent, child, grandchild, great-grandchild, sibling, aunt, uncle, niece, nephew) a member of the governing body of the sponsoring entity or of the governing body of the charter school?

O Yes ® No

If so, give details:

15. Will any relative(s) within the third degree of consanguinity or affinity (see definitions in Question 14 above) be employed by or receive any compensation or remuneration from the sponsoring entity, charter school, or the management company of the charter school?

O Yes (•) No


16. Have you ever been convicted of a misdemeanor involving moral turpitude; a felony; an offense listed in TEC 37.007(a); or an offense listed in Article 62.01(5) Code of Criminal Procedure?

O Yes ® No


SAS 529-07 Page 3 of4 Page 96 RFA 701-06-021

17. Have you ever been adjudged bankrupt? O No If so, please provide the following information.

Number of times adjudged bankrupt:

Date of each bankruptcy judgment:

Description of the circumstances surrounding each bankruptcy:

18. Have you ever been an officer, director, trustee, investment committee member, key employee, or controlling stockholder of any business, which, while you occupied any such position or capacity with respect to it, became insolvent, declared bankruptcy, or was placed under supervision or in receivership, rehabilitation, liquidation or conservatorship?

O Yes (.) No


Dated and signed this day of I hereby certify under penalty of perjury that I am acting on my owp behalf and that j/he foregoing statements are true and correct to the best of my knowledge and belief.

(Signature of Affiant)

VERIFICATION

State of County of

On this day, /jjtiS Jots * /£~i# // &}&&- (nafne of affiant) appeared before me the undersigned notary public and deposed that he/she executed the above instrument and that the statements and answers contained therein are true and correct to the best of his/ her knowledge and belief.

Subscribed and sworn to before me this j *_7 day of j_Z:r?3j£~C{_Ci_/2. L/ , 200 5*

(Notary Public)

(SEAL) My commission expires //" 3 0

SAS 529-07 Page 4 of4 Page 97 RFA 701-06-021

I



l*J Member of the governing body of the sponsoring entity

I Member of the governing body of the charter school

LJ School officer; State position as defined in TEC, §12.1012


Full Name of Proposed Charter School Henry Ford Academy: San Antonio (HFA: SA)



1. Full Name (Initials Not Acceptable) Patricia Ellen Mooradian

2, Have you ever had your name changed or used another name? ® Yes O No

If yes, give reason for the change: Marriage

Maiden name (if female): Dougherty

Other names used at any time: Patricia Ellen Derderian

3. Current home address: 950 Satterlee Rd. Bloomfield Hills, MI 48304


O S3 ^° O ^^ (because I am not a member of the governing body of the sponsoring entity or the ês

sponsoring entity is based in Texas).

4. Current home telephone number: (248) 593-6855


College: Texas Christian University, Fort Worth, TX, Bachelor's of Fine Arts, 1982

Graduate Studies:

Others:


Henry Ford Hospitals and Health Network, Trustee, 2004-Present Michigan Travel Commissioner, 2006-Present Cultural Alliance of Southeast Michigan, Board Member, 2006-Present

Mratinnal lUiigîim National AHwigf^/ Rriîrrl J7nA7.Prpeent_

D , -. SAS 529-07 P a g e l° f 4 RFA 701-06-021

Page 98



2005-Present, The Henry Ford, Dearborn, MI, President 2000-2005, The Henry Ford, Dearborn, MI, Chief Operating Officer 1990-2000, The Taubman Group, Bloomfield Hills, MI, Director of Regional Marketing


n/a



2002-2004, 2005-Present, Henry Ford Academy, Dearborn MI, Board Member 2007-Present, The Henry Ford Learning Institute, Dearborn, MI, Board Vice Chair



n/a


n/a

Page 2 of 4 SAS 529-07 RFA 701-06-021

Page 99


O Yes ® No



Yes No If so, please state the compensation you expect to receive.

Also explain any other compensation you expect to receive for service on the governing body of the sponsoring entity,


O Yes (•) No



O Yes ® No


16. Have you ever been convicted of a misdemeanor involving moral turpitude; a felony; an offense listed in TEC 37.007(a); or an offense listed in Article 62.01 (5) Code of Criminal Procedure?

O Yes ® No


SAS 529-07 Page 3 of 4 RFA 701-06-021

Page 100

17. Have you ever been adjudged bankrupt? O No If so, please provide the following information.




18. Have you ever been an officer, director, trustee, investment committee member, key employee, or controlling stockholder of any business, which, while you occupied any such position or capacity with respect to it, became insolvent, declared bankruptcy, or was placed under supervision or in receivership, rehabilitation, liquidation or conservator ship?

O Yes (•) No


Dated and signed this day of M I hereby certify under penalty of perjury that I am acting on my own aehalfand that the foregoing statements are true and correct to the best of my knowledge and belief.

(Signature of Affian

VERIFICATION

State of County of

On this day, ac (name of affiant) appeared before me the undersigned notary public and deposed that he/she executed the above instrument and that the statements and answers contained therein are true and correct to the best of his/ her knowledge and belief.

Subscribed and sworn to before me this day of 200

(Notary Public) /

(SEAL) My commission expires / 7

HELEN CORAK JENNINGS Notary Public, State of Michigan

County of Wayne My Commission Expiies May. 25.2013

Actta in the County of

SAS 529-07 Page 4 of4 RFA 701-06-021

Page 101



l*J Member of the governing body of the sponsoring entity

Lj Member of the governing body of the charter school

I_ I School officer: State position as defined in TEC, §12.1012





1 . Full Name (Initials Not Acceptable) Ziad QJakli

2. Have you ever had your name changed or used another name? Q Yes S! No



Other names used at any time:

3. Current home address: 3423 Malbrook Drive, Falls Church, VA 22044


O Yes RJ No O N/A (because I am not a member of the governing body of the sponsoring entity or the sponsoring entity is based in Texas).



College: Georgetown University, Bachelor of Arts: American Government

Graduate Studies:

Others:


Board Member: National Association of Manufacturers Board Member: Institute on Business and Cultural Affairs Board Member: Michigan Manufacturers Association RnarH Mf-mh^r- rWitrr. Fnv

fA SAS 529-07 Page l°f4 RFA 701-06-021

Page 102

i



2004-Present, Ford Motor Company, Dearborn, MI, Group Vice President, Government and Community Relations 2001-2004, President George W. Bush, Washington, D.C., Deputy Assistant to the President for Legislative Affairs 2000-2001, Bush-Cheney Transition Team, Washington, D.C., Senate Liaison 1998-2000, Senate Republican Secretary Paul Coverdell, Washington, D.C., Policy Director and Chief of Staff


n/a



March, 2006 to present, Henry Ford Learning Institute, Dearborn MI, Board Member



n/a


n/a

D „ f, SAS 529-07 Page2°f4 RFA 701-06-021

Page 103


O Yes ® No



O Yes No If so, please state the compensation you expect to receive.



O Yes ® No



O Yes (•) No



O Yes (S) No


SAS 529-07 Page 3 of4 RFA 701-06-021

Page 104

17. Have you ever been adjudged bankrupt? Q Yes No If so, please provide the followinginformation.





O Yes (5) No


Dated and signed this day of ,200 r. I hereby certify under penalty ofperjury that I am acting on myo\y/f behalf and that the foregoing statements are true and correct to the best of my knowledge and belief.

VERIFICATION

State of _ County of

On this day, /£-//}£> $3/3 K^— I (name of affiant) appeared before me the undersigned notary public and deposed that he/she executed the above instrument and that the statements and hiansweranswerss containecontainedd thereithereinn araree trutruee anandd correccorrectt ttoo ththee besbestt ooff his/ her knowledge and belief.

Subscribed and sworn to before me this day of J-££&UAJbJ / 200 $*. --••")/ L f̂i //\jjj^jtf/nf$a**

(Nota^^ublic)

(SEAL) My commission expires _ DEANNAM/ROWE

Notary Public, Wayrw County, Michigan My Commission Exptrn January 7,2014

SAS 529-07Page 4 of4 RFA 701-06-021

Page 105

Fourteenth Generation Open-Enrollment Charter School Applicant Biographical (MUST BE TYPED and NOTARIZED)


l^J Member of the governing body of the sponsoring entity

I—1 Member of the governing body of the charter school

LJ School officer: State position as defined in TEC, §12.1012

Full Name of Sponsoring Entity Henry Ford Learning Institute

Full Name of Proposed Charter School Henry Ford Learning Institute, San Antonio, Texas

In connection with the above-named organization and charter school application,I herewith make representations and supply information about myself as hereinafter set forth. (Attach addendum or separate sheet if space hereon is insufficient to answer any questions fully.)


1. Full Name (Initials Not Acceptable) Henry Ruben Mufioz HI

2. Have you ever had your name changed or used another name? I I Yes fxl No




3. Current home address: 235 W. Kings Hwy., San Antonio, Texas 78212


[x] Yes r~| No r~\ N/A (because 1 am not a member of the governing body of the sponsoring entity or the sponsoring entity is based in Texas).

4. Current home telephone number: 210-826-4657


College: Loyola University 1981 Communications

Graduate Studies:

Others:


P , fA SAS 529-07 Fage ' RFA 701-06-021

Page 106



1983 to 2008 Kell Munoz Architects 1017 North Main Street Suite 300, S A TX 78212 CEO


Mestizo LLC Modern On Main Kell Munoz Architects






SAS 529-07 Page 2 of4

RFA 701-06-021 Page 107


T Yes (f No



(S No If so, please state the compensation you expect to receive.



T Yes {• No



r Yes (• No



r Yes (V No

If so, give details;

SAS 529-07 Page 3 of4 RFA 701-06-021

Page 108

17. Have you ever been adjudged bankrupt? C Yes (• No If so, please provide the following information.





T Yes (V No


Dated and signed this _ _ _ _ J _ Q _ day of / hereby certify under penalty of perjury that I am acting on my/nfn behaljfond that the foregoing statements are true and correct to the best of my knowledge and belief.

VERIFICATION

State of County of

On this day, ][CioK>& K* ff)(/afv* ///name of affiant) appeared before me the undersigned notary public and deposed that he/she executed the above instrument and that the statements and answers contained therein are true and correct to the best of his/ her knowledge and belief.

Subscribed and sworn to before me this day of

(Notary

My commission expires gy» 7*0

SAS 529-07 Page 4 of4 RFA 701-06-021

Page 109



i*J Member of the governing body of the sponsoring entity

I I Member of the governing body of the charter school

1 I School officer: State position as defined in TEC, §12.1012

Ful l Name of Sponsoring Entity Henry Ford Learning Institute (HFLI)

Ful l Name of Proposed Charter School HenrY Ford Academy: San Antonio (HFA: SA)



1. Full Name (Initials Not Acceptable) Larry Holliday

2. Have you ever had your name changed or used another name? O Yes S3 No




3. Current home address: 15837 Fairfax, Southfield, MI 48075


O Yes S3 No £3 N/A (because I am not a member of the governing body of the sponsoring entity or the sponsoring entity is based in Texas).

4. Current home telephone number: (248)269-0808


College: University of Oregon, Eugene, OR, Bachelor's in Science, 1971

_ , „ ,. University of Oregon, Eugene, OR, Master's in Science Graduate Studies:

Others:


n/a

Page 1 of 4 SAS 529-07 RFA 701-06-021

Page 110



2000-Present, Learning Designs, Inc., Vice President 1997-2000, The Henry Ford Academy, Dearborn, MI, Dean of Students


Learning Designs, Inc.



1997-2000, The Henry Ford Academy, Dearborn, MI, Dean 2006 to present, Henry Ford Learning Institute, Dearborn MI, Board Member



n/a

List any professional, occupational, or vocational licenses issued by any public or governmental licensing agency or regulatory authority which you presently hold or have held in the past. (State date license was issued, issuer of license, date terminated, reasons for termination:

n/a

SAS 529-07 Page 2 of4 RFA 701-06-021

Page 111


0 Yes (*) No



Yes (•) No If so, please state the compensation you expect to receive.


14. Is any relative within the third degree of consanguinity (i.e., your parent, grandparent, great-granparcnt, child, grandchild, great-grandchild, sibling, aunt, uncle, niece, nephew) or within the third degree of affinity (i.e., your spouse or your spouse's parent, grandparent, great-granparent, child, grandchild, great-grandchild, sibling, aunt, uncle, niece, nephew) a member of the governing body of the sponsoring entity or of the governing body of the charter school?

O Yes (•) No



O Yes ® No


16. Have you ever been convicted of a misdemeanor involving moral turpitude;a felony; an offense listed in TEC 37.007(a); or an offense listed in Article 62.01(5) Code of Criminal Procedure?

O Yes ® No


SAS 529-07 Page 3 of 4 RFA 701-06-021

Page 112

Yes No17. Have you ever been adjudged bankrupt? O ® If so, please provide the following information.





O Yes ® No


Dated and signed this __________ // day of 7z ' , 200 .̂/ hereby certify under penalty of perjury that I am acting on my own behalf and that the foregoing statements are true and correct to the best of my knowledge and belief.

"7

(Signature of Affiant)

VERIFICATION

State of County of

On this day, /L^-.//* 1/_ /'W ///£(&. Mjiame of affiant) appeared before me the undersigned notary public and deposed that he/she executed the above instrument ana that the statements and answers contained therein are true and correct to the best of his/ her knowledge and belief.

Subscribed and sworn to before me this day of

(Notary Public)

(SEAL) My commission

KATHRYN E. SWIFT Notary Public, State of Michigan »«. « c°unty of Oakland My Commission ExpiresJun. 01,2013

Acting in the County of

SAS 529-07 Page 4 of 4 RFA 701-06-021

Page 113



S Member of the governing body of the sponsoring entity

Lj Member of the governing body of the charter school

D School officer: State position as defined in TEC, §12.1012





1. Full Name (Initials Not Acceptable) Fretta Reilzes

2. Have you ever had your name changed or used another name? ® Yes O No

If yes, give reason for the change: Marriage

Maiden name (if female): Helds


3. Current home address: 144 West 86th St., Apt 8-C, New York, NY 10024


^ Yes g] No £3 N/A (because I am not a member of the governing body of the sponsoring entity or the sponsoring entity is based in Texas).


5. Education: Dates, Names, locations and Degrees

College: Boston University, Boston, MA, Bachelor of Arts, 1967

„ , „ ,. Bank Street College of Education, New York, NY, Master's in Education, 1969 Graduate Studies:

Others:

6. List membership^) in professional societies and associations:

The Claremont School, Board Member Family T.L.C.J Board Member The Aaron School, Board Member Hirqt Tf-anHpr RoarH

Page 1 of 4 SAS 529-07 RFA 701-06-021

Page 114

7. List complete employment record, including sel

Henry Ford Academy San Antonio - HENRY FORD ACADEMY...

Documents

Transcript of Henry Ford Academy San Antonio - HENRY FORD ACADEMY...