iCAP Provider Application

Provider Overview
Which best describes your organization*
Accredited School
District Name
NCAA High School Code
Program Name*
Student information privacy policy URL
Primary Administrative Contact

Please provide information for the person/people best suited to answer questions from IDOE about your program. We won't publish this information -- this is just for any follow-up that IDOE may need to do.
Name of authorized representative*
Title/Position*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Staff Responsible for Indiana Course Access Program

What organizational structures are planned to ensure effective oversight, implementation, and management of the provider’s iCAP courses? Please present draft organization chart OR list of key personnel). Include administrators, director of program, faculty, and support staff (ie, enrollment, billing, etc) for the program and their duties in the program. We won't publish this information -- this is just for any follow-up that IDOE may need to do.
Enter staff information here:*
And/or upload staff documentation here:

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Program Contact

General contact information for your program. These items will be posted on the website for schools, parents, and students.
Web address*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Provider Vision, Background, and Capabilities
Describe your organization, its mission, pedagogy, and any other high-level overview information. If your organization uses courses, content, or programs from a third-party provider, please indicate the provider and the product(s) your organization purchases.*
A prospective provider must demonstrate or partner with an organization that demonstrates successful experience in furnishing courses to high school students as demonstrated by student growth in each subject area and grade level for which it proposes to provide courses. Please explain how the applicant/provider meets this requirement. *
Which course type(s) are you seeking to offer through iCAP? (select all that apply)*

Advanced Placement (AP)High schoolDual creditDual enrollment
iCAP courses are delivered to students online. How does your organization support students being successful in an online course environment?*
Describe the platform/learning management system (LMS) that your organization's online courses are delivered through. *
How much do your organization's courses currently cost?*
Attach supporting documentation as necessary.

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Provide references of successful implementation of courses in other large scale implementations.*
Provide a statement describing the types of students that your program intends to serve. *
If your program or online course participation requirements include student-teacher contact, please describe those requirements here.*
Criterion Statements

Satisfy at least ONE of the following measures of quality for each course submitted for iCAP approval and indicate if it is third-party or self-reporting:
Course level evaluation using Quality Matters for each course proposed.

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Course level evaluation using the iNACOL standards for online learning for each course proposed.

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Courses proposed are part of an approved course catalog at an Indiana institution of higher education (each course proposed).

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Assurances Letter

As a part of the application, applicants must upload a signed letter agreeing to comply with the assurances.
For district-run providers, the letter must be on school district letterhead and signed by the district superintendent.

For company-run providers, the letter must be on company letterhead and signed by an authorized representative of the company.

For higher education institution providers, the letter must be on institution letterhead and signed by an authorized representative of the institution.

Applications should use the following template:

With this letter, I agree that [applicant] will comply with the iCAP Provider approval assurances, as listed here:
1. Instruction delivered to Indiana state students is delivered by a current Indiana licensed teacher based on the IDOE assignment code in the content area or by a licensed Workplace Specialist unless the course is through a higher education provider instructor for dual enrollment and/or dual credit courses. You may refer to further information on reciprocal licensing and Alternative Licensing Paths.
2. Course content must be aligned to content standards required by the Indiana State Board of Education.
3. The Course Provider must have a plan that measures performance outcomes (including course completion data and student performance). Documentation of evaluation and monitoring of the implementation plan must be addressed within the proposal.
4. The Course Provider must provide detailed information about the enrollment and onboarding process for students, parents, and schools.
5. Be accessible to students of all abilities
  1. Not discriminate on the basis of race, creed, color, or national origin
  2. Acknowledge the responsibility to uphold any pertinent federal or state law, rules or regulations in the delivery of courses, including, without limitation, Title II of the Americans with Disabilities Act, Section 504 of Rehabilitation Act of 1973, and the Individuals with Disabilities Education Act.
  3. Adhere to Accessibility Guidelines as outlined in Section 508 Accessibility Standards from the U.S. Access Board.
    
    Produce a copy of a Voluntary Product Accessibility Template (VPat) upon request.
    
    Meet conformance level A of the World Wide Web Consortium's Web Accessibility Initiative (WAI) Web Content Accessibility Guidelines (WCAG) 2.0.
6. Comply with the privacy provisions of federal law
7. Meet reporting requirements as outlined in Indiana Code 20-30-16 (Sections 11-12).
8. Provide parents and students an evaluation of the course. Indiana Code 20-30-11(4)
9. Work with the department to negotiate an iCAP course tuition fee for an enrolled eligible student for each course offered and all course materials. This includes how the provider will address the payment structure associated with course outcomes outlined in IC 20-30-16-10.
I assure, to the best of my knowledge and belief, that the information in the application is true and correct and that the filing of the application has been duly authorized. Furthermore, I assure that the applicant is in compliance with the required assurances at the time of submission.

[signed]
Upload assurances letter here:*

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Should be Empty:

Provider Overview

Primary Administrative Contact

Staff Responsible for Indiana Course Access Program

Program Contact

Provider Vision, Background, and Capabilities

Criterion Statements

Assurances Letter