Academic Approval Concerns

Academic Approval Concerns
Lead Agencies, after exhausting other local means to communicate with noncompliant sites, should complete the following form to register academic approval concerns with LDOE.
Program Information

Please provide information about the noncompliant program partner
Program Name*
Program Administrator's Name*
Owner's Name*
Program Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Program phone number*
Please enter a valid phone number.
Program Email Address*
example@example.com
License Number*
Community Network Lead Agency Information
Please select your Community Network Lead Agency*
Person Reporting*
Reporter's Title*
Reporter's Phone Number*
Reporters Email*
example@example.com
Summary of Facts

Provide a summary of the facts that led to this report. This summary should describe the actions that have occurred, the persons involved, and the assurance(s) that is/are not being met. Include the names of everyone with whom you communicated about this issue, and attach supporting documentation, if available.
Summary of Facts*
Supporting documentation upload

Cancelof
Bulletin 140 concerns

Please select all sections of BESE Bulletin 140 that of concern
This program partners has demonstration an unwillingness or failure to comply with the following provisions (check all that apply)

Membership in the community network;Participation in the early childhood care and education accountability system: TS GOLDParticipation in the early childhood care and education accountability system: CLASS observationsParticipation in the coordinated enrollment processConcern about any act of fraud, such as the submission of false or altered documents or informationFailure to timely comply with a corrective action plan provided by the DepartmentFailure to timely submit a signed copy of the annual program partner assurancesTwo (2) unsatisfactory performance ratings within any consecutive three school years
Signature: By typing my name, I confirm that I am the person reporting and that the reported information is true and correct to the best of my knowledge and belief.

Clear
Should be Empty:

Academic Approval Concerns

Program Information

Community Network Lead Agency Information

Summary of Facts

Bulletin 140 concerns