Provider Application

Purpose, mission statement, or both [Ed 1403.01(a)(1)].

A description of the demonstrated instructor qualifications required for the program(s) and a statement assuring that the instructor(s) satisfies those qualifications [Ed 1403.01(a)(3)]. Describe your program’s policy for instructor qualifications. Note that there is no requirement for your instructors to have a state teaching certification. There is no need to attach instructor resumes; simply explain what qualifications you require of your teachers and then affirm that your instructors satisfy these requirements.

A criminal history records check policy that includes a statement affirming that the sponsoring entity shall not allow instruction or student contact by a person who has been charged pending disposition for, or convicted of, any violation or attempted violation of any of the offenses as outlined in RSA 189:13-a, V pursuant to a criminal history records check conducted by the department of safety as outlined in Saf-C 5703.06 through Saf-C 5703.11 [1403.01(a)(4)].

For the proposed instructional program(s), identify the education, program, or opportunity from Ed 306.27(v) for which students completing the learn everywhere program shall receive high school credit(s) [Ed 1403.01(b)(1)(a)].

An outline of each program for which approval is sought, which includes goals, competencies, a detailed description of the course of instruction, and a description of expected student outcomes [Ed 1403.01(b)(1)(b)].

A plan for recording student progress in meeting expected student outcomes for each course of instruction [Ed 1403.01(b)(1)(c)].

A description of how the assessment of student learning outcomes will be done [Ed 1403.01(b)(1)(d)].

The number of credits each proposed course of instruction will fulfill [Ed 1403.01(b)(1)(e)].

A description of the competency-based grading system to be used for each proposed course of instruction[Ed 1403.01(b)(1)(e)].

A description of methods for admission which shall not be designed, intended, or used to discriminate or violate individual civil rights in any manner prohibited by law [Ed 1403.01(b)(2)(a)].

A description of how the program will liaison with the local education agency (LEA) for students with an education plan pursuant to section 504 of the Rehabilitation Act [Ed 1403.01(b)(2)(b)].

A description of how the program will liaison with the LEA for a student with disabilities, consistent with the student's IEP [Ed 1403.01(b)(2)(c)].

A statement that the applicant understands that it has certain responsibilities, pursuant to Section 504 of the Rehabilitation Act, if it receives federal funds, or the Americans with Disabilities Act, as amended, to provide students with disabilities with equal access and equal opportunities to participate in the learn everywhere program, including by providing the student with reasonable accommodations [Ed 1403.01(b)(2)(d)].

A description of facilities to be used for educational instruction and a description of how the facilities will meet the priorities of the program [Ed 1403.01(b)(3)(a)].

A statement affirming that the facilities shall comply with all applicable federal and state health and safety laws, rules, and regulations [Ed 1403.01(b)(3)(b)].

Disclosure of insurance, if any, which would cover the participants in the Learn Everywhere program [Ed 1403.01(b)(4)].

The applicant is encouraged to include any additional information in this application that further explains their program and how it will meet the needs of students through the Learn Everywhere program.