Private K-12 Non-Religious School Application
Chapter 18 Application
Payment Received
Yes
No
Payment Method
Check Number or ACH Date
Amount Paid
Institution Information
Name of Institution
*
Date
-
Month
-
Day
Year
Date
Is the institution accredited through an accrediting body approved by the US Department of Education?
*
Yes
No
Name of accrediting association
Registration Period (July 1 through June 30 annually)
*
Please Select
2023-2024
2024-2025
2025-2026
Contact Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website/URL
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Registered Agent
An agent is defined as anyone who represents the institution who solicits students in the State of Wyoming. This includes events such as career fairs or school visits.
Does the institution wish to license an agent?
*
Yes
No
By accepting the terms, the institution verifies that it has carefully reviewed the qualifications and the personal data of the agent and believes that he/she will perform in accordance with Wyoming statutes and Rules and Regulations.
*
Advertising Policy
If the institution chooses to advertise that they are licensed by the Wyoming Department of Education, the student must sign the following statement: "I understand that (Name of Institution) is licensed with the Wyoming Department of Education in accordance with W.S. 21-2-401 through 21-2-407 and that neither the Department of Education nor the Wyoming State Board of Education accredits or endorses any course of study being offered by (Name of Institution)."
Institution agrees to abide by this advertising policy, W.S. 21-2-401 through 21-2-407, and Chapter 18 Rules and Regulations
*
Yes
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Staffing
List all administrators, faculty and staff
Institution certifies that the employee's qualifications and personnel data have been carefully reviewed and verifies that the employee meets the necessary qualification or the position he/she holds
*
Please explain reason for dismissal or revocation for staff member (if applicable)
Are all teachers appropriately certified and endorsed by Wyoming's Professional Teaching Standards Board (PTSB)?
*
Yes
No
Please list teachers that are not certified by PTSB
*
Please provide documentation that parents have been notified that not all teachers are certified by PTSB
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Enrollment
List grade levels served
*
Number of students enrolled in the schoool on October 1st of the current school year by grade
*
Number of students that completed high school and received a diploma issued by your school in the current year
*
Number of students that dropped out of grades 9-12 during the current school year
*
Name of English language proficiency used to determine English language status
*
Number of English Learners enrolled in the school
*
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Assessments
Name of assessments used
*
School's recommended course of study for college-bound students
*
Percent of students who have successfully completed the course of study for the current school year
*
Please explain the school improvement goals
*
School Calendar
Number of days students are in school
Number of instructional hours each day
Copy of calendar
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Supporting Documentation
Please attach PDF version
Enrollment Contract Including Tuition Fees and Refund Policy
*
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School Handbook
*
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Additional Documentation
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Payment Information
A $200 fee is required for each application. Additionally, please submit $100 for each registered agent. Checks should be sent to: Wyoming Department of Education Attn: Brenna Harris 122 W. 25th St. Suite E200 Cheyenne, WY 82002
Number of agents being registered today
*
Cost of agent registrations
Base Application Fee
Total Amount Due
Method of Payment
*
Check
ACH Transfer
Credit Card
Credit Card Processing
Check Number
Date of ACH Transfer
-
Month
-
Day
Year
Date
Assurance
By signing this application, the institution assures that this school is in compliance with local, city and county ordinaces and state laws relating to the health and safety of all person upon the premises. Additionally, the institution is in compliance with all requirements of Wyoming Private School Licensing Rules and Regulations.
Signature
*
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