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EFGHIJKJLMNOOPJQFROHSTGUOFJTFVJWOXYHJZT[Y...Certificate of Occupancy . CO Number: 420174457F . This certifies that the premises described herein conforms substantially to the approved
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FIRE DEPARTMENT 9 METROTECH CENTER BROOKLYN, N.Y. 11201-3857
BUREAU OF FIRE PREVENTION Public Buildings Unit DATE: 07.30.2018.
PREMISES
Riverton Street Charter School 118-34 Riverton Street Queens NY 11412
Riverton Street Charter School 118-34 Riverton Street Queens NY 11412
To Whom It May Concern:
Bureau of Fire Prevention, Public Buildings Unit conducted an inspection of the above-referenced premises on 11.22.2017.
XXX The inspection did not reveal any violations that FDNY Unit is authorizedto inspect and enforce.
The inspection resulted in issuance of violations of the Fire Code or other laws, rules or regulations that FDNY is authorized to inspect and enforce.
As of XXXXXX documents were submitted to FDNY as proof of correction, and such correction was deemed acceptable to FDNY
The inspection, and a review of premises records, has disclosed that the premises may not be in compliance with the lawful occupancy established by the New York City Department of Buildings.
This letter shall not be construed to be a permit for, or an approval of the premises. FDNY does not certify that the premises is free from any violation for which it has not inspected, in accordance with its standard inspection protocols. This letter shall not prevent FDNY from inspecting the premises at a later date, requiring the correction of any deficiencies its finds at the premises, and/or issuing violations against the premises for conditions that do not comply with the Fire Code or other laws, rules or regulations.
Examined by: _________________________________________ Tomasz Korbas, Supervising Inspector, PBU
Page 1 of 2
Certificate of Occupancy CO Number: 420174457F
This certifies that the premises described herein conforms substantially to the approved plans and specifications and to the requirements of all applicable laws, rules and regulations for the uses and occupancies specified. No change of use or occupancy shall be made unless a new Certificate of Occupancy is issued. This document or a copy shall be available for inspection at the building at all reasonable times.
A.
B.
C.
D.
E.
Borough: Queens
Address: 118-34 RIVERTON STREET
Building Identification Number (BIN): 4268946
Block Number: 12449
Lot Number(s): 4
Building Type: Altered
Certificate Type: Final
Effective Date: 06/09/2014
This building is subject to this Building Code: 1968 Code
For zoning lot metes & bounds, please see BISWeb.
Construction classification:
Building Occupancy Group classification:
Multiple Dwelling Law Classification:
E
None
(2008 Code)
1-D (1968 Code designation)
No. of stories: Height in feet: No. of dwelling units: 3 39 0
Fire Protection Equipment: Fire alarm system, Sprinkler system
Type and number of open spaces: None associated with this filing.
This Certificate is issued with the following legal limitations: None
Borough Comments: None
Borough Commissioner Commissioner
DOCUMENT CONTINUES ON NEXT PAGE
Page 2 of 2
Certificate of Occupancy CO Number: 420174457F
Permissible Use and Occupancy All Building Code occupancy group designations below are 2008 designations.
Floor From To
Maximum persons permitted
Live load lbs per sq. ft.
Building Code occupancy group
Dwelling or Rooming Units
Zoning use group Description of use
CEL OG 7 3 OFFICES NURSES AND TEACHERS, PANTRY LUNCH PREP ROOM
F-2 B
BAS OG320 3 MECHANICAL ROOMS, OFFICES, MULTI- PURPOSE RM. NOW SIMULTANIOUS CLECTURE GYM, DINING ROOMS
A-3 A-4 B
001 50315 3 ADMINISTRATION OFFICES, CLASS ROOMS E B
001
002 40330 3 CLASS ROOMS, TEACHERS OFFICES. E B
002
003 40330 3 CLASS ROOMS, TEACHERS OFFICES. E B
003
END OF SECTION
SCHOOL FOR CHILDREN AGES 5 TO 14 YEARS OLD. ZONING EXHIBIT FILED UNDER CRFN 2010000175459, & 2010000175458 TOTAL # OF STUDENTS 730
New York State Education Department Request for Proposals to Establish Charter Schools Authorized by the
Board of Regents
2018-19 Budget & Cash Flow Template
General Instructions and Notes for New Application Budgets and Cash Flows Templates
1 Complete ALL SIX columns in BLUE 2 Enter information into the GRAY cells
3 Cells containing RED triangles in the upper right corner in columns B through G contain guidance on that particular item
4
School district per-pupil tuition information is located on the State Aid website at https://stateaid.nysed.gov/charter/. Rows may be inserted in the worksheet to accomodate additional districts if necessary.
5
The Assumptions column should be completed for all revenue and expense items unless the item is self-explanatory. Where applicable, please reference the page number or section in the application narrative that indicates the assumption being made. For instance, student enrollment would reference the applicable page number in Section I, C of the application narrative.
- - - -
- - -
- - -
- - - -
- - -
Riverton Street Charter SchoolPROJECTED BUDGET FOR 2018-2019
July 1, 2018 to June 30, 2019Please Note: The student enrollment data is entered below in the Enrollment Section beginning in row 155. This will populate the data in row 10.
Total Revenue Total Expenses
Net Income Actual Student Enrollment
Total Paid Student Enrollment
REGULAR EDUCATION
SPECIAL EDUCATION
15,554,085 1,809,966 11,946,857 1,548,358
3,607,228 261,608 836 132
- -
OTHER
---
FUNDRAISING MANAGEMENT & GENERAL
- -- 3,868,836 - (3,868,836)
TOTAL
17,364,051 17,364,051
---
PROGRAM SERVICES
REGULAR EDUCATION
SPECIAL EDUCATION OTHER
SUPPORT SERVICES
FUNDRAISING MANAGEMENT &
GENERAL TOTAL
REVENUE REVENUES FROM STATE SOURCES
Per Pupil Revenue CY Per Pupil Rate NYCDOE $14,963.00 School District 2 (Enter Name) School District 3 (Enter Name) School District 4 (Enter Name) School District 5 (Enter Name)
14,487,741 -- -- -- -- -
14,487,741
-----
- -- -- -- -- -
14,487,741 ----
14,487,741
Special Education Revenue Grants
Stimulus Other
Other State Revenue TOTAL REVENUE FROM STATE SOURCES
REVENUE FROM FEDERAL FUNDING IDEA Special Needs Title I Title Funding - Other School Food Service (Free Lunch) Grants
Charter School Program (CSP) Planning & Implementation Other
Other Federal Revenue TOTAL REVENUE FROM FEDERAL SOURCES
LOCAL and OTHER REVENUE Contributions and Donations, Fundraising Erate Reimbursement Interest Income, Earnings on Investments, NYC-DYCD (Department of Youth and Community Developmt.) Food Service (Income from meals) Text Book Other Local Revenue
TOTAL REVENUE FROM LOCAL and OTHER SOURCES
TOTAL REVENUE
- 1,725,086
- -- -- -
14,487,741 1,725,086
- 84,880 426,112 -187,879 -393,812 -
- -- -- -
1,007,803 84,880
- -- -- -- -
56,541 -- -
2,000 -58,541
15,554,085 1,809,966
-
---
----
---
-------
- -
- -- -- -
- -- -- -- -
- -- -- -
- -- -- -- -- -- -- -
1,725,086
---
16,212,827
84,880 426,112 187,879 393,812
---
1,092,683
----
56,541 -
2,000 58,541
17,364,051
EXPENSES ADMINISTRATIVE STAFF PERSONNEL COSTS No. of Positions
Riverton Street Charter School PROJECTED BUDGET FOR 2018-2019
July 1, 2018 to June 30, 2019 Please Note: The student enrollment data is entered below in the Enrollment Section beginning in row 155. This will populate the data in row 10.
TOTAL EXPENSES 11,946,857 1,548,358 3,868,836 17,364,051
NET INCOME 3,607,228 261,608 - - (3,868,836) -
ENROLLMENT - *School Districts Are Linked To Above Entries* REGULAR EDUCATION
SPECIAL EDUCATION
TOTAL ENROLLED
NYCDOE 836 132 968 School District 2 (Enter Name) -
PROJECTED BUDGET FOR 2018-2019
July 1, 2018 to June 30, 2019 Please Note: The student enrollment data is entered below in the Enrollment Section beginning in row 155. This will populate the data in row 10.
REGULAR EDUCATION
SPECIAL EDUCATION OTHER FUNDRAISING MANAGEMENT &
GENERAL TOTAL
Total Revenue 15,554,085 1,809,966 - - - 17,364,051 Total Expenses 11,946,857 1,548,358 - - 3,868,836 17,364,051
Net Income 3,607,228 261,608 - - (3,868,836) -Actual Student Enrollment 836 132 -
Total Paid Student Enrollment - - -
PROGRAM SERVICES SUPPORT SERVICES
REGULAR EDUCATION
SPECIAL EDUCATION OTHER FUNDRAISING
MANAGEMENT & GENERAL TOTAL
Riverton Street Charter School
School District 3 (Enter Name) -School District 4 (Enter Name) -School District 5 (Enter Name) -
TOTAL ENROLLMENT 836 132 968
REVENUE PER PUPIL 18,600 13,712 -
EXPENSES PER PUPIL 14,286 11,730 -
PROJECTED BUDGET FOR 2018-2019
July 1, 2018 to June 30, 2019 Please Note: The student enrollment data is entered below in the Enrollment Section beginning in row 155. This will populate the data in row 10.
REGULAR EDUCATION
SPECIAL EDUCATION OTHER FUNDRAISING MANAGEMENT &
GENERAL TOTAL
Total Revenue 15,554,085 1,809,966 - - - 17,364,051 Total Expenses 11,946,857 1,548,358 - - 3,868,836 17,364,051
Net Income 3,607,228 261,608 - - (3,868,836) -Actual Student Enrollment 836 132 -
Total Paid Student Enrollment - - -
PROGRAM SERVICES SUPPORT SERVICES
REGULAR EDUCATION
SPECIAL EDUCATION OTHER FUNDRAISING
MANAGEMENT & GENERAL TOTAL
Assumptions DESCRIPTION OF ASSUMPTIONS -
Please note assumptions when applicable
Title II
List exact titles and staff FTE"s ( Full time equivalent)
Principal
Specialist
ELL Teacher, Academic Specialists, Behavior Support Specialist
Disclosure of Financial Interest by a Current or Proposed Charter School Education Corporation Trustee
Trustee Name:
Kisha Clinton
Name of Charter School Education Corporation (for an unmerged school, this is the Charter School Name):
Riverton Street Charter School
1. List all positions held on the education corporation board (e.g., president, treasurer, parent representative).
Trustee 2017-Current
2. Is the trustee an employee of any school operated by the Education Corporation? ____Yes ____NoX
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
3. Is the trustee an employee or agent of the management company or institutional partner of the charter school(s) governed by the Education Corporation?
X____Yes ____No
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
4. Identify each interest/transaction (and provide the requested information) that you or any of your immediate family members or any persons who live with you in your house have held or engaged in with the charter school(s) governed by the Education Corporation during the time you have served on the board, and in the six-month period prior to such service. If there has been no such financial interest or transaction, write None. Please note that if you answered Yes to Questions 2-4 above, you need not disclose again your employment status, salary, etc.
5. Identify each individual, business, corporation, union association, firm, partnership, committee proprietorship, franchise holding company, joint stock company, business or real estate trust, non-profit organization, or other organization or group of people doing business with the school(s) governed by the Education Corporation and in which such entity, during the time of your tenure as a trustee, you and/or your immediate family member(s) or person(s) living in your house had a financial interest or other relationship. If you are a member, director, officer or employee of an organization formally partnered with the school(s) that is/are doing business with the school(s) through a management or services agreement, please identify only the name of the organization, your position in the organization, and the relationship between such organization and the school(s). If there was no financial interest, write None.
Organization conducting
business with the school(s)
Nature of business
conducted
Approximate value of the
business conducted
Name of Trustee and/or immediate family member of household holding an
interest in the organization conducting business with
the school(s) and the nature of the interest
Steps Taken to Avoid
Conflict of Interest
None None None None None
Signature Date
Please note that this document is considered a public record and as such, may be made available to members of the public upon request under the Freedom of Information Law. Personal contact information provided below will be redacted.
Disclosure of Financial Interest by a Current or Proposed Charter School Education Corporation Trustee
Trustee Name:
Takashi Curd
Name of Charter School Education Corporation (for an unmerged school, this is the Charter School Name):
Riverton Street Charter School
1. List all positions held on the education corporation board (e.g., president, treasurer, parent representative).
Trustee 2017-Current
2. Is the trustee an employee of any school operated by the Education Corporation? ____Yes ____NoX
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
3. Is the trustee an employee or agent of the management company or institutional partner of the charter school(s) governed by the Education Corporation?
X____Yes ____No
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
4. Identify each interest/transaction (and provide the requested information) that you or any of your immediate family members or any persons who live with you in your house have held or engaged in with the charter school(s) governed by the Education Corporation during the time you have served on the board, and in the six-month period prior to such service. If there has been no such financial interest or transaction, write None. Please note that if you answered Yes to Questions 2-4 above, you need not disclose again your employment status, salary, etc.
5. Identify each individual, business, corporation, union association, firm, partnership, committee proprietorship, franchise holding company, joint stock company, business or real estate trust, non-profit organization, or other organization or group of people doing business with the school(s) governed by the Education Corporation and in which such entity, during the time of your tenure as a trustee, you and/or your immediate family member(s) or person(s) living in your house had a financial interest or other relationship. If you are a member, director, officer or employee of an organization formally partnered with the school(s) that is/are doing business with the school(s) through a management or services agreement, please identify only the name of the organization, your position in the organization, and the relationship between such organization and the school(s). If there was no financial interest, write None.
Organization conducting
business with the school(s)
Nature of business
conducted
Approximate value of the
business conducted
Name of Trustee and/or immediate family member of household holding an
interest in the organization conducting business with
the school(s) and the nature of the interest
Steps Taken to Avoid
Conflict of Interest
None None None None None
Signature Date
Please note that this document is considered a public record and as such, may be made available to members of the public upon request under the Freedom of Information Law. Personal contact information provided below will be redacted.
Disclosure of Financial Interest by a Current or Proposed Charter School Education Corporation Trustee
Trustee Name:
Emma Dawson
Name of Charter School Education Corporation (for an unmerged school, this is the Charter School Name):
Riverton Street Charter School
1. List all positions held on the education corporation board (e.g., president, treasurer, parent representative).
Trustee 2015-Current
2. Is the trustee an employee of any school operated by the Education Corporation? ____Yes ____NoX
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
3. Is the trustee an employee or agent of the management company or institutional partner of the charter school(s) governed by the Education Corporation?
X____Yes ____No
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
4. Identify each interest/transaction (and provide the requested information) that you or any of your immediate family members or any persons who live with you in your house have held or engaged in with the charter school(s) governed by the Education Corporation during the time you have served on the board, and in the six-month period prior to such service. If there has been no such financial interest or transaction, write None. Please note that if you answered Yes to Questions 2-4 above, you need not disclose again your employment status, salary, etc.
5. Identify each individual, business, corporation, union association, firm, partnership, committee proprietorship, franchise holding company, joint stock company, business or real estate trust, non-profit organization, or other organization or group of people doing business with the school(s) governed by the Education Corporation and in which such entity, during the time of your tenure as a trustee, you and/or your immediate family member(s) or person(s) living in your house had a financial interest or other relationship. If you are a member, director, officer or employee of an organization formally partnered with the school(s) that is/are doing business with the school(s) through a management or services agreement, please identify only the name of the organization, your position in the organization, and the relationship between such organization and the school(s). If there was no financial interest, write None.
Organization conducting
business with the school(s)
Nature of business
conducted
Approximate value of the
business conducted
Name of Trustee and/or immediate family member of household holding an
interest in the organization conducting business with
the school(s) and the nature of the interest
Steps Taken to Avoid
Conflict of Interest
None None None None None
Signature Date
Please note that this document is considered a public record and as such, may be made available to members of the public upon request under the Freedom of Information Law. Personal contact information provided below will be redacted.
Disclosure of Financial Interest by a Current or Proposed Charter School Education Corporation Trustee
Trustee Name:
Linda Green
Name of Charter School Education Corporation (for an unmerged school, this is the Charter School Name):
Riverton Street Charter School
1. List all positions held on the education corporation board (e.g., president, treasurer, parent representative). Trustee June 2017-Jan 2018
Vice President 2016-2017 Trustee 2011-2016
2. Is the trustee an employee of any school operated by the Education Corporation? ____Yes ____NoX
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
3. Is the trustee an employee or agent of the management company or institutional partner of the charter school(s) governed by the Education Corporation?
X____Yes ____No
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
4. Identify each interest/transaction (and provide the requested information) that you or any of your immediate family members or any persons who live with you in your house have held or engaged in with the charter school(s) governed by the Education Corporation during the time you have served on the board, and in the six-month period prior to such service. If there has been no such financial interest or transaction, write None. Please note that if you answered Yes to Questions 2-4 above, you need not disclose again your employment status, salary, etc.
5. Identify each individual, business, corporation, union association, firm, partnership, committee proprietorship, franchise holding company, joint stock company, business or real estate trust, non-profit organization, or other organization or group of people doing business with the school(s) governed by the Education Corporation and in which such entity, during the time of your tenure as a trustee, you and/or your immediate family member(s) or person(s) living in your house had a financial interest or other relationship. If you are a member, director, officer or employee of an organization formally partnered with the school(s) that is/are doing business with the school(s) through a management or services agreement, please identify only the name of the organization, your position in the organization, and the relationship between such organization and the school(s). If there was no financial interest, write None.
Organization conducting
business with the school(s)
Nature of business
conducted
Approximate value of the
business conducted
Name of Trustee and/or immediate family member of household holding an
interest in the organization conducting business with
the school(s) and the nature of the interest
Steps Taken to Avoid
Conflict of Interest
None None None None None
Signature Date
Please note that this document is considered a public record and as such, may be made available to members of the public upon request under the Freedom of Information Law. Personal contact information provided below will be redacted.
Disclosure of Financial Interest by a Current or Proposed Charter School Education Corporation Trustee
Trustee Name:
Angela Kiffin
Name of Charter School Education Corporation (for an unmerged school, this is the Charter School Name):
Riverton Street Charter School
1. List all positions held on the education corporation board (e.g., president, treasurer, parent representative).
Secretary 2010-Present
2. Is the trustee an employee of any school operated by the Education Corporation? ____Yes ____NoX
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
3. Is the trustee an employee or agent of the management company or institutional partner of the charter school(s) governed by the Education Corporation?
X____Yes ____No
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
4. Identify each interest/transaction (and provide the requested information) that you or any of your immediate family members or any persons who live with you in your house have held or engaged in with the charter school(s) governed by the Education Corporation during the time you have served on the board, and in the six-month period prior to such service. If there has been no such financial interest or transaction, write None. Please note that if you answered Yes to Questions 2-4 above, you need not disclose again your employment status, salary, etc.
5. Identify each individual, business, corporation, union association, firm, partnership, committee proprietorship, franchise holding company, joint stock company, business or real estate trust, non-profit organization, or other organization or group of people doing business with the school(s) governed by the Education Corporation and in which such entity, during the time of your tenure as a trustee, you and/or your immediate family member(s) or person(s) living in your house had a financial interest or other relationship. If you are a member, director, officer or employee of an organization formally partnered with the school(s) that is/are doing business with the school(s) through a management or services agreement, please identify only the name of the organization, your position in the organization, and the relationship between such organization and the school(s). If there was no financial interest, write None.
Organization conducting
business with the school(s)
Nature of business
conducted
Approximate value of the
business conducted
Name of Trustee and/or immediate family member of household holding an
interest in the organization conducting business with
the school(s) and the nature of the interest
Steps Taken to Avoid
Conflict of Interest
None None None None None
Signature Date
Please note that this document is considered a public record and as such, may be made available to members of the public upon request under the Freedom of Information Law. Personal contact information provided below will be redacted.
Disclosure of Financial Interest by a Current or Proposed Charter School Education Corporation Trustee
Trustee Name:
Deborah King
Name of Charter School Education Corporation (for an unmerged school, this is the Charter School Name):
Riverton Street Charter School
1. List all positions held on the education corporation board (e.g., president, treasurer, parent representative). Trustee 2015 - Present
Vice President 2010-2015 2. Is the trustee an employee of any school operated by the Education Corporation?
____Yes ____NoX
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
3. Is the trustee an employee or agent of the management company or institutional partner of the charter school(s) governed by the Education Corporation?
X____Yes ____No
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
4. Identify each interest/transaction (and provide the requested information) that you or any of your immediate family members or any persons who live with you in your house have held or engaged in with the charter school(s) governed by the Education Corporation during the time you have served on the board, and in the six-month period prior to such service. If there has been no such financial interest or transaction, write None. Please note that if you answered Yes to Questions 2-4 above, you need not disclose again your employment status, salary, etc.
5. Identify each individual, business, corporation, union association, firm, partnership, committee proprietorship, franchise holding company, joint stock company, business or real estate trust, non-profit organization, or other organization or group of people doing business with the school(s) governed by the Education Corporation and in which such entity, during the time of your tenure as a trustee, you and/or your immediate family member(s) or person(s) living in your house had a financial interest or other relationship. If you are a member, director, officer or employee of an organization formally partnered with the school(s) that is/are doing business with the school(s) through a management or services agreement, please identify only the name of the organization, your position in the organization, and the relationship between such organization and the school(s). If there was no financial interest, write None.
Organization conducting
business with the school(s)
Nature of business
conducted
Approximate value of the
business conducted
Name of Trustee and/or immediate family member of household holding an
interest in the organization conducting business with
the school(s) and the nature of the interest
Steps Taken to Avoid
Conflict of Interest
None None None None None
Signature Date
Please note that this document is considered a public record and as such, may be made available to members of the public upon request under the Freedom of Information Law. Personal contact information provided below will be redacted.
Disclosure of Financial Interest by a Current or Proposed Charter School Education Corporation Trustee
Trustee Name:
Rochelle Noel
Name of Charter School Education Corporation (for an unmerged school, this is the Charter School Name):
Riverton Street Charter School
1. List all positions held on the education corporation board (e.g., president, treasurer, parent representative). Vice President 2017-Current
Trustee 2016-2017 President 2010-2016
2. Is the trustee an employee of any school operated by the Education Corporation? ____Yes ____NoX
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
3. Is the trustee an employee or agent of the management company or institutional partner of the charter school(s) governed by the Education Corporation?
X____Yes ____No
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
4. Identify each interest/transaction (and provide the requested information) that you or any of your immediate family members or any persons who live with you in your house have held or engaged in with the charter school(s) governed by the Education Corporation during the time you have served on the board, and in the six-month period prior to such service. If there has been no such financial interest or transaction, write None. Please note that if you answered Yes to Questions 2-4 above, you need not disclose again your employment status, salary, etc.
5. Identify each individual, business, corporation, union association, firm, partnership, committee proprietorship, franchise holding company, joint stock company, business or real estate trust, non-profit organization, or other organization or group of people doing business with the school(s) governed by the Education Corporation and in which such entity, during the time of your tenure as a trustee, you and/or your immediate family member(s) or person(s) living in your house had a financial interest or other relationship. If you are a member, director, officer or employee of an organization formally partnered with the school(s) that is/are doing business with the school(s) through a management or services agreement, please identify only the name of the organization, your position in the organization, and the relationship between such organization and the school(s). If there was no financial interest, write None.
Organization conducting
business with the school(s)
Nature of business
conducted
Approximate value of the
business conducted
Name of Trustee and/or immediate family member of household holding an
interest in the organization conducting business with
the school(s) and the nature of the interest
Steps Taken to Avoid
Conflict of Interest
None None None None None
Signature Date
Please note that this document is considered a public record and as such, may be made available to members of the public upon request under the Freedom of Information Law. Personal contact information provided below will be redacted.
Disclosure of Financial Interest by a Current or Proposed Charter School Education Corporation Trustee
Trustee Name:
Keisha Phillips-Kong
Name of Charter School Education Corporation (for an unmerged school, this is the Charter School Name):
Riverton Street Charter School
1. List all positions held on the education corporation board (e.g., president, treasurer, parent representative). President 2016-Current
Vice President 2015-2016 Trustee 2012-2015
2. Is the trustee an employee of any school operated by the Education Corporation? ____Yes ____NoX
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
3. Is the trustee an employee or agent of the management company or institutional partner of the charter school(s) governed by the Education Corporation?
X____Yes ____No
If Yes, for each school, please provide a description of the position(s) you hold, your responsibilities, your salary and your start date.
4. Identify each interest/transaction (and provide the requested information) that you or any of your immediate family members or any persons who live with you in your house have held or engaged in with the charter school(s) governed by the Education Corporation during the time you have served on the board, and in the six-month period prior to such service. If there has been no such financial interest or transaction, write None. Please note that if you answered Yes to Questions 2-4 above, you need not disclose again your employment status, salary, etc.
5. Identify each individual, business, corporation, union association, firm, partnership, committee proprietorship, franchise holding company, joint stock company, business or real estate trust, non-profit organization, or other organization or group of people doing business with the school(s) governed by the Education Corporation and in which such entity, during the time of your tenure as a trustee, you and/or your immediate family member(s) or person(s) living in your house had a financial interest or other relationship. If you are a member, director, officer or employee of an organization formally partnered with the school(s) that is/are doing business with the school(s) through a management or services agreement, please identify only the name of the organization, your position in the organization, and the relationship between such organization and the school(s). If there was no financial interest, write None.
Organization conducting
business with the school(s)
Nature of business
conducted
Approximate value of the
business conducted
Name of Trustee and/or immediate family member of household holding an
interest in the organization conducting business with
the school(s) and the nature of the interest
Steps Taken to Avoid
Conflict of Interest
None None None None None
Signature Date
Please note that this document is considered a public record and as such, may be made available to members of the public upon request under the Freedom of Information Law. Personal contact information provided below will be redacted.