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ATTACHMENT A

By Marion Lee,2014-11-28 12:52
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ATTACHMENT A

    New Mexico Public Education Commission

BOARD OF FINANCE APPLICATION

    CONTENTS

    ; AFFIDAVIT FOR BUSINESS MANAGER

    ; STATEMENT FROM GOVERNING BODY

    ; AFFIDAVITS FOR GOVERNING BODY MEMBERS

    ; DECLARATION OR CERTIFICATE OF INSURANCE

    Revised 5-1-09

    Application for Board of Finance Designation

The application shall include:

    (1) an affidavit or affidavits, signed by the personnel who will be given the responsibility of keeping the financial records of the charter school, describing the training completed, professional licensure held and degrees earned by them;

    (2) a statement signed by every member of the governing body that the governing body agrees to consult with the department on any matter not covered by the manual of accounting and budgeting before taking any action relating to funds held as a board of finance; 6.80.4 NMAC 12

    (3) a signed affidavit from each governing body member declaring that the member is not a governing body member of any other charter school and that the member was not a governing body member of another charter school that was suspended or failed to receive or maintain their board of finance designation;

    (4) a copy of the certificate of insurance that indicates that the person who will be entrusted with handling the funds of the charter school is adequately insured;

    (5) a letter from Poms & Associates verifying that the charter school is a participant in the public school insurance authority; and

(6) a copy of the business manager’s current license.

Revised 5-1-09

    AFFIDAVIT OF BUSINESS MANAGER

STATE OF NEW MEXICO )

     )

    COUNTY OF SANTA FE )

     I, _________________________, after being duly sworn, states as follows:

    1. My name is _____________________________ and I live in the City of ____________________, County of _____________________, New Mexico.

    2. I have been hired as the business manager for the _______________________ Charter School.

    3. In my duties as business manager for ____________________________ Charter School, I will be given the responsibility of keeping the financial records of the charter school.

    4. I have completed the following training in the maintenance of financial records:

     a)

    b)

    c)

5. I currently hold a license as a certified school business official for the State of New Mexico, and

    have attached a copy of this license to this document.

6. I have earned the following degrees:

    Degree earned Educational Institution

______________________________________ _________________________

    [signature of business manager] Date

    Business Manager for _______________________ Charter School

Subscribed and sworn to before me, this _____day of ________, 20___.

     [Notary Seal:]

__________________________________

    [signature of Notary]

__________________________________

    [typed name of Notary]

     NOTARY PUBLIC

     My commission expires: ________________, 20____.

    Revised 5-1-09

    STATEMENT OF GOVERNING BODY TO CONSULT WITH PED

    We, the undersigned, make up the governing body of the ____________________________Charter School in _____________________, New Mexico.

    In accordance with 6.80.4.16 NMAC, we agree to consult with the New Mexico Public Education Department on any matter not covered by the manual of accounting and budgeting before taking any action related to funds held as a board of finance.

We make this statement as part of ____________________________ Charter School’s application as

    a board of finance under 6.80.4.16 NMAC.

    We understand that we must notify the New Mexico Public Education Commission within 30 days of a change in Business Manager for the school, and a new, signed “Affidavit of Business Manager” must be submitted.

    We understand that we must submit a new, signed statement to the New Mexico Public Education Commission within 60 days of a change in membership of our governing body.

________________________________ [signature]

    ______________________, Member of Governing Body of ____________________ Charter School

________________________________ [signature]

    ______________________, Member of Governing Body of ____________________ Charter School

________________________________ [signature]

    ______________________, Member of Governing Body of ____________________ Charter School

________________________________ [signature]

    ______________________, Member of Governing Body of ____________________ Charter School

________________________________ [signature]

    ______________________, Member of Governing Body of ____________________ Charter School

_________________

    Date

    Revised 5-1-09

     AFFIDAVIT OF GOVERNING BODY MEMBER

STATE OF NEW MEXICO )

     )

    COUNTY OF )

     I, ______________________________, after being duly sworn, state as follows:

    1. My name is __________________________ and I reside in ___________________, New Mexico.

    2. I am a member of the governing body of the ___________________________ charter school located in _____________________________, New Mexico.

    3. I am not currently a member of any governing body of any other charter school.

    4. I have never been a member of any governing body of any other charter school that was suspended or failed to receive or maintain their board of finance designation.

5. I have read the school’s conflict of interest policy and I assure that the school will be in compliance

    with state and federal law when administering grants and entering into contracts.

___________________________________ _________________

     [Signature] Date

    ___________________________, Governing Body Member of _______________________ Charter School

Subscribed and sworn to before me, this _____day of ___________, 20___.

     [Notary Seal:]

__________________________________

    [signature of Notary]

__________________________________

    [typed name of Notary]

     NOTARY PUBLIC

     My commission expires: ________________, 20____.

Revised 5-1-09

    DECLARATION OR CERTIFICATE OF INSURANCE

    Please attach or insert a copy of a declaration or certificate of insurance that indicates that the financial manager of ___________________________________Charter School is adequately bonded and the Charter School is insured through Public School Insurance Authority.

Attached:

     Bonding Declaration from: ______________________________________________________

     [Name of institution or agency]

     Certificate of Insurance from: ____________________________________________________

     [Name of institution or agency]

    Revised 5-1-09

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