ÐÏࡱá>þÿ ÞáþÿÿÿÜÝÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Á]à ø¿>bjbjºöºö 4üØœ)\Øœ)\6 ÿÿÿÿÿÿ·  ˆˆˆˆˆÿÿÿÿœœœ8ÔtH„œênìÌÊ––––Ê’\|Ø@inknknknknknkn$Öp¶Œsz�nˆÿ ÊÊÿ ÿ �nˆˆ––4¤nO/O/O/ÿ Fˆ–ˆ–inO/ÿ inO/O/nÑMÉP–ÿÿÿÿÀ.ýÚÐ¥ÏÿÿÿÿE!FÙN Unºn0ênùNÐv‹!âv@ÉPvˆÉPŒ ": O/R f ™   �n�nm(â   ênÿ ÿ ÿ ÿ ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿv          > N: ºÚÁÏÍø×îÐÂÈë¿Ú Qualified Zone Academy Bond (QZAB) Program Application District or charter school name: FORMTEXT County-district number: District or charter school contact person: Address 1: Address 2: City: Zip code: Telephone: Email address:  Eligibility Applicant must check one of the following to establish QZAB eligibility:  FORMCHECKBOX  The applicant district or charter school is located in a designated empowerment zone or enterprise community. Please specify: _______________________ or  FORMCHECKBOX  The campuses benefiting from the QZAB proceeds will have at least 35 percent of students attending (as of the date of issuance of the bonds) who are eligible for free or reduced-cost lunches under the school lunch program established under the National School Lunch Act. Bond Authorization Requested There is no limit to the amount of bond authorization that may be requested per district or charter school. Numeric amount of the bond authorization requested:(Example: $5,250,000) Written amount of the bond authorization requested:(Example: Five million two hundred fifty thousand dollars) The applicant must commit to spending at least 10 percent of the proceeds within six months of issuing the QZABs and 100 percent of the proceeds within three years of issuing the QZABs: Anticipated issue date:Anticipated amount of funds spent six months after issue:$Anticipated amount of funds spent three years after issue:$ ºÚÁÏÍø×îÐÂÈë¿Ú Qualified Zone Academy Bond (QZAB) Program Application Assurance of Private Business Contribution The district or charter school must provide written assurance of commitment from a private entity or private entities to make qualified contributions totaling a present value equal to not less than 10 percent of the proceeds of the bond issue. The commitment must state that the 10 percent match is valued at a reasonable fair market value offered by any entity providing similar products or services. The 10 percent contribution may include the following: equipment for use in the qualified zone academy (including state-of-the-art technology and vocational equipment) technical assistance in developing curriculum or in training teachers in order to promote appropriate market-driven technology in the classroom services of employees as volunteer mentors internships, field trips, or other educational opportunities outside the academy for students any other property (including cash) or service specified by the public school district or charter school The chief executive of each participating entity must sign the assurance. Please indicate that the signed assurance is attached to this application by checking the box below.  FORMCHECKBOX  Assurance attached Prohibition against Using Funds for New Construction Repair, renovation, and retrofitting of existing buildings are the only types of construction that qualify under the QZAB program. QZAB proceeds may not be used for new construction. New construction includes projects such as additions to existing buildings and/or new freestanding buildings.  FORMCHECKBOX  Acknowledgement that applicant will not use funds for new construction (please check) ºÚÁÏÍø×îÐÂÈë¿Ú Qualified Zone Academy Bond (QZAB) Program Application County-district number:District or charter school name: New Academic Program and Project Description(s) New Academic Program. The district or charter school must design the proposed program in cooperation with business partners to enhance the academic curriculum, increase graduation and employment rates, and better prepare students for the rigors of college and the increasingly complex work world. The district or charter school and at least one of the business partners together must create a plan for a new academic program and indicate how their combined efforts can improve student education. Postsecondary education and training programs and existing programs are not eligible. Students in the proposed program must be subject to the same academic standards and assessments as other students educated by the eligible district or charter school.Describe the new academic program:Identify how the new academic program will enhance the academic curriculum, increase graduation and employment rates, and better prepare students for the rigors of college and the increasingly complex work world:Identify how the new academic program was designed in cooperation with business partner(s):Identify, in the following table, the campuses at which the new academic program will be implemented:Campus InformationProject Elements (check all that apply for each project)Estimated CostNarrative DescriptionCampus name: _________________ Campus no. (9 digits): ___________ Economically disadvantaged: ___% (percentage of students eligible for free and reduced-cost lunch) FORMCHECKBOX  Repairs or rehabilitation$ FORMCHECKBOX  Equipment$ FORMCHECKBOX  Developing course materials for education$ FORMCHECKBOX  Training teachers and other school personnel$Campus name: _________________ Campus no. (9 digits): ___________ Economically disadvantaged: ___% (percentage of students eligible for free and reduced-cost lunch) FORMCHECKBOX  Repairs or rehabilitation$ FORMCHECKBOX  Equipment$ FORMCHECKBOX  Developing course materials for education$ FORMCHECKBOX  Training teachers and other school personnel$Issuance costs (if any):$Cannot exceed 2% of the bond authorization amount requestedTotal project costs and issuance costs:$Must equal the bond authorization amount requested This page may be reproduced to provide additional space as needed. ºÚÁÏÍø×îÐÂÈë¿Ú Qualified Zone Academy Bond (QZAB) Program Application County-district number:District or charter school name: As used in this application: "Agency" means the ºÚÁÏÍø×îÐÂÈë¿Ú (ºÚÁÏÍø×îÐÂÈë¿Ú); and "Applicant" means the entity eligible to apply for bond authorization. If the application is approved, "applicant" means the entity granted the bond authorization. Statement of provisions and assurances for the bond authorization requested in this application: A. The applicant certifies that 100 percent of the proceeds of the QZABs will be used for some or all of the following qualified purposes: Rehabilitating or repairing the public school facility in which an academy is established Providing equipment for use at an academy Developing course materials for education to be provided at an academy Training teachers and other school personnel in an academy Issuance costs not to exceed 2 percent of total bond proceeds QZAB proceeds may not be used for new construction. New construction includes projects such as additions to existing buildings and/or new freestanding buildings. Within six months of issuance, the applicant must have entered into contract(s) for use of proceeds equal to 10 percent of issuance. Additionally, 100 percent of the bond proceeds are to be used for a qualified purpose and must be spent within three years of the date of issuance. B. Debt instruments: A school district applicant must issue one or more of the following four types of debt instruments: General Obligation Bond—authorized under the authority of the Texas Education Code, Chapter 45, Subchapter A Lease Purchase—authorized under the Texas Local Government Code, §271.005, pertaining to personal property Time Warrant—authorized under the Texas Education Code, §45.103 Maintenance Tax Note—authorized under the Texas Education Code, §45.108 A charter school applicant must issue only the following type of debt instrument: Revenue Bond—as authorized under the Texas Education Code, Chapter 53, Subchapter C C. Compliance with the Davis-Bacon Act: The applicant certifies that all laborers and mechanics employed by contractors and subcontractors on projects funded directly by or assisted in whole or in part by and through the federal government under this authorization will be paid wages at rates not less than those prevailing on projects of a character similar in the locality as determined by the secretary of labor in accordance with 40 United States Code (USC), Chapter 31, Subchapter IV. (American Recovery and Reinvestment Act §1606) The applicant certifies that all contracts will include language that acknowledges that all contractors or subcontractors must pay laborers and mechanics employed under the contract no less than locally prevailing wages for corresponding work on similar projects in the area. The U.S. Department of Labor determines locally prevailing wage rates. Wage determinations:  HYPERLINK "http://www.access.gpo.gov/davisbacon/" http://www.access.gpo.gov/davisbacon/ Texas wage determinations are linked from the following site:  HYPERLINK "http://www.access.gpo.gov/davisbacon/tx.html" http://www.access.gpo.gov/davisbacon/tx.html D. The applicant certifies that the applicant will comply with any arbitrage and rebate requirements that may apply on governmental tax-exempt bonds. ºÚÁÏÍø×îÐÂÈë¿Ú Qualified Zone Academy Bond (QZAB) Program Application for County-district number:District or charter school name: Statement of provisions and assurances for the bond authorization requested in this application (continued): E. The applicant certifies that the person signing this application has been properly delegated this authority. F. In the conduct of the bond authorization, the applicant is subject to Texas State Board of Education rules and commissioner of education rules pertaining to school facilities and the bond authorization and to the laws of the State of Texas governing this bond authorization. This document constitutes the entire agreement between the agency and the applicant for the bond authorization. G. The agency may conduct desk reviews or on-site monitoring reviews to determine compliance with the approved application and the applicable statute(s), law(s), regulations, and guidelines. H. If the applicant, in the agency’s sole determination, fails or refuses for any reason to perform any of its obligations under this contract, the agency may impose such sanctions as it may consider appropriate. The cancellation, termination, or suspension of this bond authorization, if imposed, will become effective at the close of business on the day the applicant receives written notice thereof from the agency. I. The applicant, to the extent permitted by law, must hold the agency harmless from and must indemnify the agency against all claims, demands, and causes of action of whatever kind or nature asserted by any third party and occurring or in any way incident to, arising from, or in connection with any acts of the applicant, its agents, employees, and subcontractors, done in the conduct of the bond authorization. J. The applicant must maintain its records and accounts in a manner that ensures a full accounting for all funds received and expended by the applicant in connection with the bond authorization. The applicant must retain these records and accounts and make them available for programmatic or financial audit by the agency and by others authorized by law or regulation to make such an audit for a period of not less than five years from the date of the end of debt service. If an audit has been announced, the records must be retained until the audit has been completed. K. The applicant certifies that no funds provided under this bond authorization will be used to purchase supplies, equipment, or services from any companies found to be guilty of unfair business practices within 12 months from the determination of guilt. L. The applicant certifies that no funds will be used to pay for religious worship, instruction, or proselytization, or for any equipment or supplies for such, or for any construction, remodeling, repair, operation, or maintenance of any facility or part of a facility to be used for religious worship, instruction, or proselytization (34 Code of Federal Regulations, §76.532, and Public Law 107-110, §9505). M. The applicant certifies that it will consider security criteria developed by the Texas School Safety Center under the Texas Education Code, §37.2051, for the design of any construction or major renovation of an existing facility using funds obtained under this bond authorization. ºÚÁÏÍø×îÐÂÈë¿Ú Qualified Zone Academy Bond (QZAB) Program Application for County-district number:District or charter school name: I certify that, to the best of my knowledge, the information in this application is true and correct; I further certify that any ensuing program and activity will be conducted in accordance with all applicable federal and state laws and regulations, the application guidelines and instructions, and the statement of provisions and assurances contained in this document. This application is for an academy program established and operated under the supervision of an eligible local education agency (LEA), as defined in Section 14101 of the Elementary and Secondary Education Act of 1965. Printed name of superintendent or other authorized district or charter school officialXX Original signature (blue ink preferred) of superintendent or other authorized district or charter school official Date Please return to: ºÚÁÏÍø×îÐÂÈë¿Ú Document Control Center ATTN: QZAB 1701 North Congress Avenue Austin, TX 78701 The ºÚÁÏÍø×îÐÂÈë¿Ú does not accept fax or email submissions. We will consider applications on a first-come, first-served basis, until the allocations are fully committed. Questions? 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