Phased School Reopening Health and Safety Plan Template

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Phased School Reopening
         Health and Safety Plan Template
Each school entity must create a Health and Safety Plan which will serve as the local guidelines
for all instructional and non- instructional school reopening activities. As with all emergency
plans, the Health and Safety Plan developed for each school entity should be tailored to the
unique needs of each school and should be created in consultation with local health agencies.
Given the dynamic nature of the pandemic, each plan should incorporate enough flexibility to
adapt to changing conditions. The templates provided in this toolkit can be used to document a
school entity’s Health and Safety Plan, with a focus on professional learning and
communications, to ensure all stakeholders are fully informed and prepared for a local phased
reopening of school facilities. A school entity’s Health and Safety Plan must be approved by its
governing body and posted on the school entity’s publicly available website prior to the
reopening of school. School entities should also consider whether the adoption of a new policy
or the modification of an existing policy is necessary to effectively implement the Health and
Safety Plan.

Each school entity should continue to monitor its Health and Safety Plan throughout the year
and update as needed. All revisions should be reviewed and approved by the governing body
prior to posting on the school entity’s public website.

                                                                                   Page 1 of 34
Table of Contents

Health and Safety Plan ........................................................................................................... 3
   Type of Reopening .................................................................................................................... 4
   Pandemic Coordinator/Team .................................................................................................... 5
   Key Strategies, Policies, and Procedures ................................................................................. 6
      Cleaning, Sanitizing, Disinfecting and Ventilation .................................................................. 8
      Social Distancing and Other Safety Protocols ....................................................................... 9
      Monitoring Student and Staff Health .................................................................................... 16
      Other Considerations for Students and Staff ....................................................................... 20
   Health and Safety Plan Professional Development ................................................................. 27
   Health and Safety Plan Communications ................................................................................ 29
Health and Safety Plan Summary ....................................................................................... 30
   Facilities Cleaning, Sanitizing, Disinfecting and Ventilation .................................................... 30
   Social Distancing and Other Safety Protocols ......................................................................... 30
   Monitoring Student and Staff Health ....................................................................................... 31
   Other Considerations for Students and Staff ........................................................................... 32
Health and Safety Plan Governing Body Affirmation Statement ............................... 34

This resource draws on a resource created by the Council of Chief State School Officers
(CCSSO) that is based on official guidance from multiple sources to include: the Centers for
Disease Control and Prevention, the White House, American Academy of Pediatrics, Learning
Policy Institute, American Enterprise Institute, Rutgers Graduate School of Education, the World
Health Organization, the Office of the Prime Minister of Norway as well as the departments of
education/health and/or offices of the governor for Idaho, Montana, New York, Texas and
Washington, DC.

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Health and Safety Plan: Arts Academy Charter School
All decision-makers should be mindful that as long as there are cases of COVID-19 in the community, there are no strategies that
can completely eliminate transmission risk within a school population. The goal is to keep transmission as low as possible to safely
continue school activities. All school activities must be informed by Governor Wolf’s Process to Reopen Pennsylvania. The
administration has categorized reopening into three broad phases: red, yellow, or green. These designations signal how counties
and/or regions may begin easing some restrictions on school, work, congregate settings, and social interactions:

   •   The Red Phase: Schools remain closed for in-person instruction and all instruction must be provided via remote learning,
       whether using digital or non-digital platforms. Provisions for student services such as school meal programs should continue.
       Large gatherings are prohibited.
   •   The Yellow Phase and Green Phase: Schools may provide in-person instruction after developing a written Health and Safety
       Plan, to be approved by the local governing body (e.g. board of directors/trustees) and posted on the school entity’s publicly
       available website.

Based on your county’s current designation (i.e., red, yellow, green) and the best interests of your local community, indicate which
type of reopening your LEA has selected by checking the appropriate box in row three of the table below. Use the remainder of the
template to document your LEA’s plan to bring back students and staff, how you will communicate the type of reopening with
stakeholders in your community, and the process for continued monitoring of local health data to assess implications for school
operations and potential adjustments throughout the school year.

Depending upon the public health conditions in any county within the Commonwealth, there could be additional actions, orders, or
guidance provided by the Pennsylvania Department of Education (PDE) and/or the Pennsylvania Department of Health (DOH)
designating the county as being in the red, yellow, or green phase. Some counties may not experience a straight path from a red
designation, to a yellow, and then a green designation. Instead, cycling back and forth between less restrictive to more restrictive
designations may occur as public health indicators improve or worsen. This means that your school entity should account for
changing conditions in your local Health and Safety Plan to ensure fluid transition from more to less restrictive conditions in each of
the phase requirements as needed.

                                                                                                                            Page 3 of 34
Type of Reopening

Key Questions

   •   How do you plan to bring students and staff back to physical school buildings, particularly if you still need social distancing in
       place?
   •   How did you engage stakeholders in the type of re-opening your school entity selected?
   •   How will you communicate your plan to your local community?
   •   Once you reopen, what will the decision-making process look like to prompt a school closure or other significant modification
       to operations?

Based on your county’s current designation and local community needs, which type of reopening has your school entity
selected?

       ☐      Total reopen for all students and staff (but some students/families opt for distance learning out of safety/health
              concern).

       ☐      Scaffolded reopening: Some students are engaged in in-person learning, while others are distance learning (i.e., some
              grade levels in-person, other grade levels remote learning).

       ☒      Blended reopening that balances in-person learning and remote learning for all students (i.e., alternating days or
              weeks).

       ☐      Total remote learning for all students. (Plan should reflect future action steps to be implemented and conditions that
              would prompt the decision as to when schools will re-open for in-person learning).

Anticipated launch date for in-person learning (i.e., start of blended, scaffolded, or total reopening):

August 31st, 2020

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Pandemic Coordinator/Team

Each school entity is required to identify a pandemic coordinator and/or pandemic team with defined roles and responsibilities for
health and safety preparedness and response planning during the phased reopening of schools. The pandemic coordinator and team
will be responsible for facilitating the local planning process, monitoring implementation of your local Health and Safety Plan, and
continued monitoring of local health data to assess implications for school operations and potential adjustments to the Health and
Safety Plan throughout the school year. To ensure a comprehensive plan that reflects the considerations and needs of every
stakeholder in the local education community, LEAs are encouraged to establish a pandemic team to support the pandemic
coordinator. Inclusion of a diverse group of stakeholders is critical to the success of planning and implementation. LEAs are highly
encouraged to make extra effort to engage representatives from every stakeholder group (i.e., administrators, teachers, support staff,
students, families, community health official or other partners), with a special focus on ensuring that the voices of underrepresented
and historically marginalized stakeholder groups are prioritized. In the table below, identify the individual who will serve as the
pandemic coordinator and the stakeholder group they represent in the row marked “Pandemic Coordinator”. For each additional
pandemic team member, enter the individual’s name, stakeholder group they represent, and the specific role they will play in
planning and implementation of your local Health and Safety Plan by entering one of the following under “Pandemic Team Roles and
Responsibilities”:

   •   Health and Safety Plan Development: Individual will play a role in drafting the enclosed Health and Safety Plan;
   •   Pandemic Crisis Response Team: Individual will play a role in within-year decision making regarding response efforts in the
       event of a confirmed positive case or exposure among staff and students; or
   •   Both (Plan Development and Response Team): Individual will play a role in drafting the plan and within-year decision
       making regarding response efforts in the event of confirmed positive case.

                                                                               Pandemic Team Roles and Responsibilities
        Individual(s)            Stakeholder Group Represented
                                                                                          (Options Above)
 Elaine Hersh                   Administration                          Pandemic Coordinator/Team Member

 Shawn Lynch                    Administration                          Plan Development and Response Team

 Andrea Angstadt                School Nurse                            Plan Development and Response Team

 Kristen Stachina               Guidance Counselor                      Plan Development and Response Team

                                                                                                                         Page 5 of 34
Director of Educational Support
 Kathleen Adolt-Silva                                                   Plan Development and Response Team
                                Services
 Clayton Howard                 IT Director                             Plan Development

 Amy Reid                       Business Administrator                  Plan Development
                                National School Lunch Program
 Heather Woodell                                                        Plan Development
                                Coordinator/Main Office Manager
                                Grants & Development Manager
 Andrew Worley                  Arts Events & Box Office Coordinator    Plan Development

 Cesar Medina                   Building Manager                        Plan Development and Response Team

 Brooke Hosey                   Parent                                  Plan Development

Key Strategies, Policies, and Procedures

Once your LEA has determined the type of reopening that is best for your local community and established a pandemic coordinator
and/or pandemic team, use the action plan templates on the following pages to create a thorough plan for each of the requirements
outlined in the Pennsylvania Department of Education’s Preliminary Guidance for Phased Reopening of PreK-12 Schools.

For each domain of the Health and Safety Plan, draft a detailed summary describing the key strategies, policies, and procedures
your LEA will employ to satisfy the requirements of the domain. The domain summary will serve as the public-facing description of
the efforts your LEA will take to ensure health and safety of every stakeholder in your local education community. Thus, the summary
should be focused on the key information that staff, students, and families will require to clearly understand your local plan for the
phased reopening of schools. You can use the key questions to guide your domain summary.

For each requirement within each domain, document the following:

   •   Action Steps under Yellow Phase: Identify the discrete action steps required to prepare for and implement the requirement
       under the guidelines outlined for counties in yellow. List the discrete action steps for each requirement in sequential order.

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•   Action Steps under Green Phase: Identify the specific adjustments the LEA or school will make to the requirement during
       the time period the county is designated as green. If implementation of the requirement will be the same regardless of county
       designation, then type “same as Yellow” in this cell.
   •   Lead Individual and Position: List the person(s) responsible for ensuring the action steps are fully planned and the school
       system is prepared for effective implementation.
   •   Materials, Resources, and/or Supports Needed: List any materials, resources, or support required to implement the
       requirement.
   •   Professional Development (PD) Required: In order to implement this requirement effectively, will staff, students, families, or
       other stakeholders require professional development?

In the following tables, an asterisk (*) denotes a mandatory element of the plan. All other requirements are highly encouraged to the
extent possible.

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Cleaning, Sanitizing, Disinfecting, and Ventilation

Key Questions

   •   How will you ensure the building is cleaned and ready to safely welcome staff and students?
   •   How will you procure adequate disinfection supplies meeting OSHA and CDC requirements for COVID-19?
   •   How often will you implement cleaning, sanitation, disinfecting, and ventilation protocols/procedures to maintain staff and
       student safety?
   •   What protocols will you put in place to clean and disinfect throughout an individual school day?
   •   Which stakeholders will be trained on cleaning, sanitizing, disinfecting, and ventilation protocols? When and how will the
       training be provided? How will preparedness to implement as a result of the training be measured?

Summary of Responses to Key Questions:

ServiceMaster, a cleaning company that the Arts Academy Charter School contracts with for cleaning services, will provide
deep cleaning to the Arts Academy Building daily, after all students have left the school building. This cleaning will begin
days before students begin coming to the building on August 31st, 2020. As a part of this year’s cleaning contract,
ServiceMaster will also provide many of their cleaning products for the Maintenance Staff to have on hand for use during
the school day. The Arts Academy Charter School will also be purchasing additional cleaning and disinfecting products
from Fuller Paper Supply Company.

Cleaning and disinfecting of desks, shared materials, and high traffic areas will take place throughout the school day
during scheduled intervals. Additional cleaning and disinfecting, as well as sanitization, will occur during the cleaning
services provided by ServiceMaster.

All staff and teacher will be trained on cleaning and disinfecting procedures and products as is appropriate for their
responsibilities during the day. Maintenance staff will be trained on how to provide deep cleaning during the school day.
All trainings will be conducted by ServiceMaster.

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Materials, Resources,     PD
                              Action Steps                     Action Steps                 Lead Individual
   Requirements                                                                                                 and or Supports       Required
                           under Yellow Phase                under Green Phase               and Position
                                                                                                                     Needed            (Y/N)
* Cleaning,            •    Service Master has been      •   Service Master has been      Cesar Medina,       Various cleaning        Y
  sanitizing,               employed and will clean          employed and will clean      Building Manager    products purchased
  disinfecting, and         the entire building every        the entire building every                        from ServiceMaster
  ventilating               week night. Our                  week night. Our                                  and Fuller Paper and
  learning spaces,          maintenance department           maintenance department                           Supply Co.
  surfaces, and any         will complete daily              will complete daily
  other areas used          cleaning of the hand             cleaning of the hand
  by students (i.e.,        railings, door knobs and         railings, door knobs and
  restrooms,                other areas that are             other areas that are
  drinking                  touched on a daily basis.        touched on a daily basis.
  fountains,           •    Maintenance Staff and        •   Maintenance Staff and
  hallways, and             Faculty will work together       Faculty will work together
  transportation)           to clean and sanitize            to clean and sanitize
                            areas of the building that       areas of the building that
                            have been used                   have been used
                            throughout the day.              throughout the day.
                       •    All desks and other          •   All desks and other
                            classroom materials will         classroom materials will
                            be wiped and disinfected         be wiped and disinfected
                            after use.                       after use.
Other cleaning,        •    Additional hand sanitizing   •   Additional hand sanitizing   Elaine Hersh,       Hand sanitizer          N
sanitizing,                 stations have been               stations have been           Principal           dispensers, hand
disinfecting, and           purchased to be installed        purchased to be installed                        sanitizer, windows
ventilation                 inside of all classrooms.        inside of all classrooms.
practices                   Students and staff will be       Students and staff will be
                            encouraged to use these          encouraged to use these
                            stations multiple times          stations multiple times
                            during a class period and        during a class period and
                            whenever leaving or              whenever leaving or
                            entering a classroom.            entering a classroom.
                       •    All windows inside of        •   All windows inside of
                            classrooms will remain           classrooms will remain
                            open during the day when         open during the day when
                            appropriate.                     appropriate.

      Social Distancing and Other Safety Protocols

                                                                                                                             Page 9 of 34
Key Questions

   •   How will classrooms/learning spaces be organized to mitigate spread?
   •   How will you group students with staff to limit the number of individuals who come into contact with each other throughout the
       school day?
   •   What policies and procedures will govern use of other communal spaces within the school building?
   •   How will you utilize outdoor space to help meet social distancing needs?
   •   What hygiene routines will be implemented throughout the school day?
   •   How will you adjust student transportation to meet social distancing requirements?
   •   What visitor and volunteer policies will you implement to mitigate spread?
   •   Will any of these social distancing and other safety protocols differ based on age and/or grade ranges?
   •   Which stakeholders will be trained on social distancing and other safety protocols? When and how will the training be
       provided? How will preparedness to implement as a result of the training be measured?

Summary of Responses to Key Questions:

Classrooms will be measured and arranged to allow for 6 feet of social distancing between all students. All non essential
classroom furniture (teacher desks, movable shelving units, etc.) will be removed from classrooms to allow for student
desks to be 6ft apart.

Students will be grouped into classrooms according to their grade level. These groups will be arranged to allow for the
maximum number of students in the classroom will respecting 6ft social distancing. Students will primarily remain in the
same classroom for the entire day with teachers rotating between classrooms. There are a few exceptions to this so that
students can eat breakfast and lunch in classrooms and experience their art classes to the greatest extent possible.

Additional hand sanitizing stations have been purchased and will be placed inside every classroom. This will allow
teachers to encourage frequent use of hand sanitizer whenever a student enters or exits a classroom.

As a charter school, the Arts Academy relies on the transportation departments of our students’ home districts. We have
been in consistent communication with those districts to keep them abreast of our plans for the upcoming school year.
The Arts Academy does utilize a school bus to transport our figure skating students to the Steel Ice Center and back. We
are creating social distancing and cleaning procedures for the school bus.

                                                                                                                       Page 10 of 34
The Arts Academy Charter School will restrict all non essential visitors from the building during school ours. Exceptions
      may be made in the event that there is a maintenance issue that requires immediate attention. This issues will be reviewed
      by administration and, in the even that outside workers need to be permitted in the building, strict procedures will be
      followed to limit the exposure of students and staff to the workers.

      Faculty and staff will be trained on social distancing procedures during staff in-service prior to the start of in person
      instruction. Parents will be made aware, through the school website, social media, and email, of social distancing, and
      visitation procedures.

      All staff will be required to sign off that they have attended and understand all trainings as they relate to social distancing
      during the period hybrid instruction.

                                                                                                                      Materials, Resources,     PD
                                Action Steps                       Action Steps                 Lead Individual and
   Requirements                                                                                                         and or Supports       Required
                             under Yellow Phase                  under Green Phase                   Position
                                                                                                                             Needed            (Y/N)
* Classroom/             •    All classrooms will be         •   All classrooms will be         Elaine Hersh,         Student Desks, PPE,     Y
  learning space              arranged in manner that            arranged in manner that        Principal             Maintenance Staff
  occupancy that              allows for students to be          allows for students to be                            Support
  allows for 6 feet of        spaced at least 6 feet             spaced at least 6 feet
  separation among            apart from each other.             apart from each other.
  students and staff     •    Classrooms are arranged        •   Classrooms are arranged
  throughout the              in a manner that allows for        in a manner that allows for
  day, to the                 teachers to have 6ft of            teachers to have 6ft of
  maximum extent              space from students in the         space from students in the
  feasible                    front (relative orientation)       front (relative orientation)
                              of the classroom. Face             of the classroom. Face
                              shields and other PPE will         shields and other PPE will
                              be provided to staff               be provided to staff
                              members as is                      members as is
                              appropriate.                       appropriate.

                                                                                                                                  Page 11 of 34
Materials, Resources,     PD
                               Action Steps                       Action Steps                 Lead Individual and
   Requirements                                                                                                        and or Supports       Required
                            under Yellow Phase                  under Green Phase                   Position
                                                                                                                            Needed            (Y/N)
* Restricting the       •    Breakfast and lunch will       •   Breakfast and lunch will       Elaine Hersh,         Disposable meal         N
  use of cafeterias          be served in student               be served in student           Principal             containers, garbage
  and other                  classrooms. Cafeteria will         classrooms. Cafeteria will                           cans, hand sanitizer
  congregate                 not be used for meals.             not be used for meals.
  settings, and
  serving meals in
  alternate settings
  such as
  classrooms
* Hygiene practices     •    Additional hand sanitizing     •   Additional hand sanitizing     Elaine Hersh,         Hand sanitizer          N
  for students and           stations will be placed            stations will be placed        Principal             dispensers, hand
  staff including the        inside of each classroom.          inside of each classroom.                            sanitizer
  manner and            •    Teachers will encourage        •   Teachers will encourage
  frequency of               students to frequently use         students to frequently use
  hand-washing and           the hand sanitizing                the hand sanitizing
  other best                 stations.                          stations.
  practices
* Posting signs, in     •    Signage will be posted         •   Signage will be posted         Shawn Lynch,          Appropriate Signage     N
  highly visible             throughout the building            throughout the building        Assistant Principal   and adhesives
  locations, that            reminding all to wear              reminding all to wear
  promote everyday           masks, frequently wash             masks, frequently wash
  protective                 their hands, and keep 6ft          their hands, and keep 6ft
  measures, and              apart.                             apart.
  how to stop the       •    Additional signage will be     •   Additional signage will be
  spread of germs            posted in high traffic areas       posted in high traffic areas
                             informing all of which             informing all of which
                             direction traffic will flow.       direction traffic will flow.

                                                                                                                                   Page 12 of 34
Materials, Resources,     PD
                              Action Steps                       Action Steps                 Lead Individual and
   Requirements                                                                                                       and or Supports       Required
                           under Yellow Phase                  under Green Phase                   Position
                                                                                                                           Needed            (Y/N)
* Identifying and      •    Visitation during the          •   Visitation during the          Shawn Lynch,          Security Cameras and    N
  restricting non-          school day will be                 school day will be             Assistant Principal   monitors.
  essential visitors        restricted to emergency            restricted to emergency
  and volunteers            maintenance staff only.            maintenance staff only.
                            These visits will be               These visits will be
                            approved by                        approved by
                            administration on case by          administration on case by
                            case basis.                        case basis.

* Handling sporting    •    The Arts Academy               •   The Arts Academy               Shawn Lynch,          Outside space           N
  activities for            Charter School does not            Charter School does not        Assistant Principal
  recess and                participate in any sporting        participate in any sporting
  physical                  activities.                        activities.
  education classes    •    Recess and Physical            •   Recess and Physical
  consistent with           Education classes will be          Education classes will be
  the CDC                   held outside of the                held outside of the
  Considerations            building and activities will       building and activities will
  for Youth Sports          be restricted to those that        be restricted to those that
                            allow for appropriate              allow for appropriate
                            social distancing, per CDC         social distancing, per CDC
                            and PDH, and activities            and PDH, and activities
                            that allow students to             that allow students to
                            safely wear masks.                 safely wear masks.

                                                                                                                                Page 13 of 34
Materials, Resources,     PD
                              Action Steps                       Action Steps                 Lead Individual and
   Requirements                                                                                                       and or Supports       Required
                           under Yellow Phase                  under Green Phase                   Position
                                                                                                                           Needed            (Y/N)
Limiting the sharing   •    Students will be assigned      •   Students will be assigned      Elaine Hersh,         Laptops, Online         Y
of materials among          a laptop that they will use        a laptop that they will use    Principal             Curriculum, Parent
students                    for the entirety of the            for the entirety of the                              support
                            school year. AACS will be          school year. AACS will be
                            using an online curriculum         using an online curriculum
                            that will eliminate the need       that will eliminate the need
                            to share textbooks,                to share textbooks,
                            papers, and other                  papers, and other
                            materials.                         materials.
                       •    Parents will be informed of    •   Parents will be informed of
                            items that are acceptable          items that are acceptable
                            for students to bring to           for students to bring to
                            school.                            school.

Staggering the use     •    Students will remain in        •   Students will remain in        Elaine Hersh,                                 N
of communal                 one classroom for the              one classroom for the          Principal
spaces and                  entire school day.                 entire school day.
hallways               •    During times when              •   During times when
                            students must use the              students must use the
                            hallway, teachers will be          hallway, teachers will be
                            trained on the procedure           trained on the procedure
                            that will be used in the           that will be used in the
                            hallways.                          hallways.
                       •    Hallways will be monitored     •   Hallways will be monitored
                            by staff members                   by staff members
                            throughout the day.                throughout the day.
                            These staff will                   These staff will
                            consistently communicate           consistently communicate
                            to support students and            to support students and
                            staff and provide for a            staff and provide for a
                            safe environment.                  safe environment.

                                                                                                                                 Page 14 of 34
Materials, Resources,     PD
                             Action Steps                       Action Steps                 Lead Individual and
   Requirements                                                                                                      and or Supports       Required
                          under Yellow Phase                  under Green Phase                   Position
                                                                                                                          Needed            (Y/N)
Adjusting             •    The Arts Academy               •   The Arts Academy               Elaine Hersh,                                 N
transportation             Charter School will                Charter School will            Principal
schedules and              support the procedures of          support the procedures of
practices to create        the sending districts.             the sending districts.
social distance
between students
Limiting the number   •    Classrooms will be             •   Classrooms will be             Shawn Lynch,                                  N
of individuals in          arranged to allow for 6ft of       arranged to allow for 6ft of   Assistant Principal
classrooms and             distance between                   distance between
other learning             students.                          students.
spaces, and           •    Students will remain in        •   Students will remain in
interactions               their classroom during the         their classroom during the
between groups of          school day, for the most           school day, for the most
students                   part.                              part.
                      •    Teachers will rotate           •   Teachers will rotate
                           between classrooms.                between classrooms
Other social          •    Staff access to typical        •   Staff access to typical        Elaine Hersh,                                 N
distancing and             gathering places (Main             gathering places (Main         Principal
safety practices           Office, staff room, copy           Office, staff room, copy
                           rooms) will be extremely           rooms) will be extremely
                           limited.                           limited.
                      •    Procedures will be             •   Procedures will be
                           developed and enforced             developed and enforced
                           regarding student                  regarding student
                           restroom use.                      restroom use.

                                                                                                                               Page 15 of 34
Monitoring Student and Staff Health

Key Questions

   •   How will you monitor students, staff, and others who interact with each other to ensure they are healthy and not exhibiting
       signs of illness?
   •   Where, to whom, when, and how frequently will the monitoring take place (e.g. parent or child report from home or upon
       arrival to school)?
   •   What is the policy for quarantine or isolation if a staff, student, or other member of the school community becomes ill or has
       been exposed to an individual confirmed positive for COVID-19?
   •   Which staff will be responsible for making decisions regarding quarantine or isolation requirements of staff or students?
   •   What conditions will a staff or student confirmed to have COVID-19 need to meet to safely return to school? How will you
       accommodate staff who are unable to uncomfortable to return?
   •   How will you determine which students are willing/able to return? How will you accommodate students who are unable or
       uncomfortable to return?
   •   When and how will families be notified of confirmed staff or student illness or exposure and resulting changes to the local
       Health and Safety Plan?
   •   Which stakeholders will be trained on protocols for monitoring student and staff health? When and how will the training be
       provided? How will preparedness to implement as a result of the training be measured?

Summary of Responses to Key Questions:

Before the start of the school year, each family will receive a “symptom checklist” that is to be reviewed each morning
before sending students to the school building. Staff member will receive the same checklist and will be instructed to
follow the same procedures and students.

Upon arrival to the building, all students and staff will have their temperature taken. Anyone with a temperature will be
isolated and their temperature will be retaken. Staff that have a fever will be told to go home. Students with a fever will be
isolated until transportation from campus has been arranged and someone has picked up the student from school.

Students that are exhibiting symptoms during the school day will be isolated until transportation can be arranged and the
student(s) can leave campus. Staff exhibiting symptoms during the day will be asked to return home. If they are unable to
safely transport themselves, administration will work with the staff member to identify safe transportation from the school.

                                                                                                                         Page 16 of 34
The decision to isolate a student or staff member will be made by the school nurse. The school nurse will also coordinate
the release of that individual to an approved contact in the case of a student or under a staff members’ own power. Based
on the symptoms displayed, the school nurse will contact the appropriate health organization for further guidance and next
steps with regard to testing and reporting of known data.

Virtual instruction will be an option for any student while they are quarantined and/or continue to experience symptoms or
difficulties as a result of being exposed to COVID-19. This will be coordinated by the students’ family and school
administration.

Communication regarding changes to the Local Health and Safety plan or Covid-19 exposures in the building will occur
through email blast to the appropriate parties, social media, and updates to the school’s website. The Arts Academy will
follow directions given by the Lehigh County Department of Health with regards to the message that is put out to our
community.

The school nurses will be trained on protocols for monitoring student and staff heath. This training will be completed prior
to the start of the 2020-2021 school year. The school nurses will also keep up to date with any changes or guidance
concerning COVID-19 as it is released by the appropriate government agencies.

                                                                                                               Page 17 of 34
Materials, Resources,      PD
                              Action Steps                      Action Steps                  Lead Individual
   Requirements                                                                                                     and or Supports        Required
                           under Yellow Phase                 under Green Phase                and Position
                                                                                                                         Needed             (Y/N)
* Monitoring           •    All families will receive a   •   All families will receive a   Shawn Lynch,          Covid-19 symptom         Y
  students and staff        check list to be reviewed         check list to be reviewed     Assistant Principal   check list provided by
  for symptoms and          each morning before               each morning before                                 the PA Department of
  history of                sending their students to         sending their students to                           Health
  exposure                  the school building.              the school building.
                       •    All staff will receive a      •   All staff will receive a
                            check list to be reviewed         check list to be reviewed
                            each morning before               each morning before
                            coming to the school.             coming to the school
                       •    Staff and students will       •   Staff and students will
                            have their temperatures           have their temperatures
                            taken before entering the         taken before entering the
                            school building.                  school building.
                       •    Upon learning that student    •   Upon learning that student
                            or staff member has been          or staff member has been
                            exposed to or is showing          exposed to or is showing
                            symptoms of COVID-19,             symptoms of COVID-19,
                            the Arts Academy will             the Arts Academy will
                            follow the guidelines set         follow the guidelines set
                            for the by the                    for the by the
                            Pennsylvania and Lehigh           Pennsylvania and Lehigh
                            County Health                     County Health
                            Departments as well as            Departments as well as
                            the Pennsylvania                  the Pennsylvania
                            Department of Education           Department of Education
                            and the Office of the             and the Office of the
                            Governor.                         Governor.

                                                                                                                                Page 18 of 34
Materials, Resources,     PD
                               Action Steps                       Action Steps                   Lead Individual
   Requirements                                                                                                      and or Supports       Required
                            under Yellow Phase                  under Green Phase                 and Position
                                                                                                                          Needed            (Y/N)
* Isolating or          •    Upon learning that a staff     •   Upon learning that a staff     Elaine Hersh        Thermometers and        Y
  quarantining               member or student is               member or student is                               other appropriate
  students, staff, or        showing symptoms of                showing symptoms of                                testing materials
  visitors if they           COVID-19, that person(s)           COVID-19, that person(s)
  become sick or             will be isolated in a              will be isolated in a
  demonstrate a              designated space away              designated space away
  history of                 from the rest of the school        from the rest of the school
  exposure                   community in the building          community in the building
                             at that time. Those                at that time. Those
                             individuals will remain in         individuals will remain in
                             the insolation room until          the insolation room until
                             they can be safely                 they can be safely
                             transported off campus.            transported off campus.
                             Symptomatic individuals        •   The Arts Academy will
                             will be referred to an             await guidance from the
                             appropriate health care            Lehigh County and/or
                             provider for testing.              Pennsylvania Department
                        •    The Arts Academy will              of Health as to whether or
                             await guidance from the            not the symptomatic
                             Lehigh County and/or               individual(s) will need to
                             Pennsylvania Department            be quarantined.
                             of Health as to whether or     •   Lenient attendance
                             not the symptomatic                polices will be put in place
                             individual(s) will need to         for students and staff that
                             be quarantined.                    must be quarantined.
                        •    Lenient attendance
                             polices will be put in place
                             for students and staff that
                             must be quarantined.

                                                                                                                               Page 19 of 34
Materials, Resources,     PD
                                 Action Steps                       Action Steps                   Lead Individual
   Requirements                                                                                                        and or Supports       Required
                              under Yellow Phase                  under Green Phase                 and Position
                                                                                                                            Needed            (Y/N)
* Returning isolated      •    According to Pennsylvania      •   According to Pennsylvania      Elaine Hersh,       N/A                     N
  or quarantined               Department of Health               Department of Health           Principal
  staff, students, or          guidance, all staff,               guidance, all staff,
  visitors to school           students or visitors will be       students or visitors will be
                               able to return to the              able to return to the
                               school after at least 10           school after at least 10
                               days from symptom onset            days from symptom onset
                               and have been fever free           and have been fever free
                               for 72 hours.                      for 72 hours.
Notifying staff,          •    The Arts Academy will use      •   The Arts Academy will use      Elaine Hersh,       N/A                     N
families, and the              the school’s website,              the school’s website,          Principal
public of school               social media, and student          social media, and student
closures and                   information                        information
within-school-year             communication system to            communication system to
changes in safety              communicate any and all            communicate any and all
protocols                      changes to the school’s            changes to the school’s
                               policies, procedures,              policies, procedures,
                               calendar, and daily                calendar, and daily
                               schedules.                         schedules.
Other monitoring          •    The Arts Academy will          •   The Arts Academy will          Andrea Angstadt,                            N
and screening                  await and follow any               await and follow any           School Nurse
practices                      additional guidance                additional guidance
                               provided by state and              provided by state and
                               local health departments           local health departments
                               as they relate to                  as they relate to
                               monitoring and screening           monitoring and screening
                               practices.                         practices.

      Other Considerations for Students and Staff

      Key Questions

          •   What is the local policy/procedure regarding face coverings for staff? What is the policy/procedure for students?

                                                                                                                                  Page 20 of 34
•   What special protocols will you implement to protect students and staff at higher risk for severe illness?
   •   How will you ensure enough substitute teachers are prepared in the event of staff illness?
   •   How will the LEA strategically deploy instructional and non-instructional staff to ensure all students have access to quality
       learning opportunities, as well as supports for social emotional wellness at school and at home?

Summary of Responses to Key Questions:

As of July 1st, 2020, the Pennsylvania Department of Health is requiring that all individuals wear a face mask when they
leave their homes. With this guidance in mind, all students, staff, and visitors will be required to wear a mask when they
are in the school building. The Arts Academy Charter School will work with families of students that require
accommodations to this directive. Similarly, administration will work with staff members that have difficulty following this
directive because of a medical condition.

In the case of students and staff that are higher risk for severe illness, the administration and nursing team will review each
situation on a case by case basis. The school will work with the student and their family and, when appropriate, the
individual’s health provider to develop a plan that allows the student to access their education while limiting risk to their
health and safety.

The Arts Academy currently employs one full time building substitute and has several substitutes that will be used on a per
diem basis for coverage. The Arts Academy is also prepared to use other full-time staff members to provide coverage for
classes if necessary.

The Arts Academy has purchased Accelarate Education, an online curriculum, and Schoology, an online instructional
ecosystem, that will allow instruction to occur while students are in the building and attending classes virtually. These
tools will be used throughout the school year to provide a consistent, standards-based learning experience for our
students. In the event that all of our instruction will need to move to a virtual learning situation, these tools will allow our
instruction to continue seamlessly.

                                                                                                                          Page 21 of 34
Materials, Resources,     PD
                              Action Steps                    Action Steps                Lead Individual
   Requirements                                                                                               and or Supports       Required
                           under Yellow Phase               under Green Phase              and Position
                                                                                                                   Needed            (Y/N)
* Protecting           •    In the case of students     •   In the case of students     Andrea Angstadt,                            N
  students and staff        and staff that are higher       and staff that are higher   School Nurse
  at higher risk for        risk for severe illness,        risk for severe illness,
  severe illness
                            the administration and          the administration and
                            nursing team will review        nursing team will review
                            each situation on a             each situation on a
                            case by case basis.             case by case basis.
                            The school will work            The school will work
                            with the student and            with the student and
                            their family and, when          their family and, when
                            appropriate, the                appropriate, the
                            individual’s health             individual’s health
                            provider to develop a           provider to develop a
                            plan that allows the            plan that allows the
                            student to access their         student to access their
                            education while limiting        education while limiting
                            risk to their health and        risk to their health and
                            safety.                         safety.

                                                                                                                        Page 22 of 34
Materials, Resources,     PD
                               Action Steps                    Action Steps                Lead Individual
   Requirements                                                                                                and or Supports       Required
                            under Yellow Phase               under Green Phase              and Position
                                                                                                                    Needed            (Y/N)
* Use of face           •    As of July 1st, 2020, the   •   As of July 1st, 2020, the   Elaine Hersh,       Face coverings/masks    N
  coverings (masks           Pennsylvania                    Pennsylvania                Principal
  or face shields) by        Department of Health is         Department of Health is
  all staff
                             requiring that all              requiring that all
                             individuals wear a face         individuals wear a face
                             mask when they leave            mask when they leave
                             their homes. With this          their homes. With this
                             guidance in mind, all           guidance in mind, all
                             students, staff, and            students, staff, and
                             visitors will be required       visitors will be required
                             to wear a mask when             to wear a mask when
                             they are in the school          they are in the school
                             building. The Arts              building. The Arts
                             Academy Charter                 Academy Charter
                             School will work with           School will work with
                             families of students that       families of students that
                             require                         require
                             accommodations to this          accommodations to this
                             directive. Similarly,           directive. Similarly,
                             administration will work        administration will work
                             with staff members that         with staff members that
                             have difficulty following       have difficulty following
                             this directive because of       this directive because of
                             a medical condition.            a medical condition.

                                                                                                                         Page 23 of 34
Materials, Resources,     PD
                               Action Steps                    Action Steps                Lead Individual
   Requirements                                                                                                and or Supports       Required
                            under Yellow Phase               under Green Phase              and Position
                                                                                                                    Needed            (Y/N)
* Use of face           •    As of July 1st, 2020, the   •   As of July 1st, 2020, the   Elaine Hersh,       Face coverings/Masks    N
  coverings (masks           Pennsylvania                    Pennsylvania                Principal
  or face shields) by        Department of Health is         Department of Health is
  older students (as
                             requiring that all              requiring that all
  appropriate)
                             individuals wear a face         individuals wear a face
                             mask when they leave            mask when they leave
                             their homes. With this          their homes. With this
                             guidance in mind, all           guidance in mind, all
                             students, staff, and            students, staff, and
                             visitors will be required       visitors will be required
                             to wear a mask when             to wear a mask when
                             they are in the school          they are in the school
                             building. The Arts              building. The Arts
                             Academy Charter                 Academy Charter
                             School will work with           School will work with
                             families of students that       families of students that
                             require                         require
                             accommodations to this          accommodations to this
                             directive. Similarly,           directive. Similarly,
                             administration will work        administration will work
                             with staff members that         with staff members that
                             have difficulty following       have difficulty following
                             this directive because of       this directive because of
                             a medical condition.            a medical condition.

                                                                                                                         Page 24 of 34
Materials, Resources,     PD
                          Action Steps                    Action Steps                Lead Individual
  Requirements                                                                                            and or Supports       Required
                       under Yellow Phase               under Green Phase              and Position
                                                                                                               Needed            (Y/N)
Unique safety      •    In the case of students     •   In the case of students     Elaine Hersh,       N                       N
protocols for           and staff that are higher       and staff that are higher   Principal
students with           risk for severe illness,        risk for severe illness,
complex needs or
                        the administration and          the administration and
other vulnerable
individuals
                        nursing team will review        nursing team will review
                        each situation on a             each situation on a
                        case by case basis.             case by case basis.
                        The school will work            The school will work
                        with the student and            with the student and
                        their family and, when          their family and, when
                        appropriate, the                appropriate, the
                        individual’s health             individual’s health
                        provider to develop a           provider to develop a
                        plan that allows the            plan that allows the
                        student to access their         student to access their
                        education while limiting        education while limiting
                        risk to their health and        risk to their health and
                        safety.                         safety.

                                                                                                                    Page 25 of 34
Materials, Resources,     PD
                             Action Steps                     Action Steps                 Lead Individual
   Requirements                                                                                                and or Supports       Required
                          under Yellow Phase                under Green Phase               and Position
                                                                                                                    Needed            (Y/N)
Strategic             •    Teacher schedules have       •   Teacher schedules have       Elaine Hersh,                               N
deployment of staff        been created that allows         been created that allows     Principal
                           for teachers to provide in       for teachers to provide in
                           person instruction as well       person instruction as well
                           as virtual instruction.          as virtual instruction.
                      •    Support teachers will be     •   Support teachers will be
                           strategically deployed to        strategically deployed to
                           ensure that all students         ensure that all students
                           receive their FAPE.              receive their FAPE.
                      •    The Arts Academy             •   The Arts Academy
                           employs one full time            employs one full time
                           building substitute and          building substitute and
                           several per diem                 several per diem
                           substitutes that will be         substitutes that will be
                           used to provide coverage         used to provide coverage
                           when needed.                     when needed.

                                                                                                                         Page 26 of 34
Health and Safety Plan Professional Development

 The success of your plan for a healthy and safe reopening requires all stakeholders to be prepared with the necessary knowledge
 and skills to implement the plan as intended. For each item that requires professional development, document the following
 components of your professional learning plan.

     •   Topic: List the content on which the professional development will focus.
     •   Audience: List the stakeholder group(s) who will participate in the professional learning activity.
     •   Lead Person and Position: List the person or organization that will provide the professional learning.
     •   Session Format: List the strategy/format that will be utilized to facilitate participant learning.
     •   Materials, Resources, and or Supports Needed: List any materials, resources, or support required to implement the
         requirement.
     •   Start Date: Enter the date on which the first professional learning activity for the topic will be offered.
     •   Completion Date: Enter the date on which the last professional learning activity for the topic will be offered.

                                                                                   Materials, Resources,
                                                Lead Person and          Session                                             Completion
          Topic                 Audience                                              and or Supports        Start Date
                                                    Position             Format                                                Date
                                                                                           Needed
                                                                                   Appropriate training
Disinfectant and Cleaning                                             Teacher
                                                                                   and reference            August 17,      August 28,
of desks and other          All Staff          ServiceMaster          Inservice
                                                                                   materials provided by    2020            2020
classroom materials                                                   Training
                                                                                   Service Master
                                                                                   Hand sanitizer and
Hand Sanitization and                                                 Teacher
                            All students and                                       hand sanitizer           August 17,      August 28,
Proper use of Face                             Andrea Angstadt        Inservice
                            staff                                                  dispensers, face         2020            2020
Coverings                                                             Training
                                                                                   coverings/masks
Review of Policies and                                                Teacher
                                                                                   Policies/Procedures      August 17,      August 28,
Procedures as they relate   All Staff          Mary Gotzon            Inservice
                                                                                   relating to COVID-19     2020            2020
to COVID-19 and Staff                                                 Training
                                                                                   Laptops, internet
                                                                      Teacher
                            Academic                                               access, Accelerate       August 17,      August 28,
Accelerate Education                           Kathleen Adolt-Silva   Inservice
                            Faculty                                                Education training and   2020            2020
                                                                      Training
                                                                                   reference Materials

                                                                                                                          Page 27 of 34
Materials, Resources,
                               Lead Person and      Session                                             Completion
        Topic      Audience                                       and or Supports       Start Date
                                   Position         Format                                                Date
                                                                      Needed
                                                              Laptops, internet
                                                 Teacher
                                                              access, Schoology        August 17,      August 28,
Schoology       All Faculty   Clayton Howard     Inservice
                                                              training and reference   2020            2020
                                                 Training
                                                              Materials

                                                                                                     Page 28 of 34
Health and Safety Plan Communications

 Timely and effective family and caregiver communication about health and safety protocols and schedules will be critical. Schools
 should be particularly mindful that frequent communications are accessible in non-English languages and to all caregivers (this is
 particularly important for children residing with grandparents or other kin or foster caregivers). Additionally, LEAs should establish
 and maintain ongoing communication with local and state authorities to determine current mitigation levels in your community.

                                                           Lead Person and                                                         Completion
               Topic                      Audience                                Mode of Communications           Start Date
                                                                Position                                                             Date
Information about start of 2020-2021                      Elaine Hersh,
                                       All Stakeholders                         School Website, Email Blasts      July 23, 2020   July 23, 2020
School Year                                               Principal
                                                                                School Website, Social Media,
Changes to Policies, Procedures,                          Elaine Hersh,                                           August 31,
                                       All Stakeholders                         Student Information System                        TBD
Calendar, and/or Daily Schedule                           Principal                                               2020
                                                                                Communication Tools
Changes to current mitigation levels   Arts Academy       Andrea Angstadt,      Communication provided by
                                                                                                                  July 23, 2020   TBD
of COVID-19 in the community           Administration     School Nurse          state and local health agencies

                                                                                                                                Page 29 of 34
Health and Safety Plan Summary: (INSERT LEA or SCHOOL NAME)
Anticipated Launch Date: August 31, 2020

Use these summary tables to provide your local education community with a detailed overview of your Health and Safety Plan. LEAs
are required to post this summary on their website. To complete the summary, copy and paste the domain summaries from the
Health and Safety Plan tables above.

Facilities Cleaning, Sanitizing, Disinfecting and Ventilation

 Requirement(s)                                                   Strategies, Policies and Procedures
 * Cleaning, sanitizing, disinfecting, and ventilating learning      •       Service Master has been employed and will clean the entire
   spaces, surfaces, and any other areas used by students                    building every week night. Our maintenance department will
   (i.e., restrooms, drinking fountains, hallways, and                       complete daily cleaning of the hand railings, door knobs and
   transportation)                                                           other areas that are touched on a daily basis.
                                                                     •       Maintenance Staff and Faculty will work together to clean and
                                                                             sanitize areas of the building that have been used throughout
                                                                             the day.
                                                                     •       All desks and other classroom materials will be wiped and
                                                                             disinfected after use.

Social Distancing and Other Safety Protocols

 Requirement(s)                                                     Strategies, Policies and Procedures
 * Classroom/learning space occupancy that allows for 6 feet             •     All classrooms will be arranged in manner that allows for
   of separation among students and staff throughout the day,                  students to be spaced at least 6 feet apart from each other.
   to the maximum extent feasible                                        •     Classrooms are arranged in a manner that allows for
                                                                               teachers to have 6ft of space from students in the front
 * Restricting the use of cafeterias and other congregate                      (relative orientation) of the classroom. Face shields and
   settings, and serving meals in alternate settings such as                   other PPE will be provided to staff members as is
                                                                               appropriate.
   classrooms
                                                                         •     Breakfast and lunch will be served in student classrooms.
                                                                               Cafeteria will not be used for meals.
                                                                         •     Additional hand sanitizing stations will be placed inside of
                                                                               each classroom.

                                                                                                                             Page 30 of 34
Requirement(s)                                                Strategies, Policies and Procedures
* Hygiene practices for students and staff including the         •   Teachers will encourage students to frequently use the hand
  manner and frequency of hand-washing and other best                sanitizing stations.
  practices                                                      •   Signage will be posted throughout the building reminding all
                                                                     to wear masks, frequently wash their hands, and keep 6ft
* Posting signs, in highly visible locations, that promote           apart.
  everyday protective measures, and how to stop the spread       •   Additional signage will be posted in high traffic areas
                                                                     informing all of which direction traffic will flow.
  of germs
                                                                 •   Visitation during the school day will be restricted to
                                                                     emergency maintenance staff only. These visits will be
* Handling sporting activities consistent with the CDC               approved by administration on case by case basis.
  Considerations for Youth Sports for recess and physical        •   The Arts Academy Charter School does not participate in any
  education classes                                                  sporting activities.
                                                                 •   Recess and Physical Education classes will be held outside
Limiting the sharing of materials among students                     of the building and activities will be restricted to those that
                                                                     allow for appropriate social distancing, per CDC and PDH,
Staggering the use of communal spaces and hallways                   and activities that allow students to safely wear masks.

Adjusting transportation schedules and practices to create
social distance between students

Limiting the number of individuals in classrooms and other
learning spaces, and interactions between groups of
students

Coordinating with local childcare regarding on site care,
transportation protocol changes and, when possible, revised
hours of operation or modified school-year calendars

Other social distancing and safety practices

Monitoring Student and Staff Health

                                                                                                                    Page 31 of 34
Requirement(s)                                                     Strategies, Policies and Procedures
* Monitoring students and staff for symptoms and history               •   All families will receive a check list to be reviewed each
  of exposure                                                              morning before sending their students to the school building.
                                                                       •   All staff will receive a check list to be reviewed each morning
* Isolating or quarantining students, staff, or visitors if they           before coming to the school.
  become sick or demonstrate a history of exposure                     •   Staff and students will have their temperatures taken before
                                                                           entering the school building.
* Returning isolated or quarantined staff, students, or                •   Upon learning that student or staff member has been exposed
                                                                           to or is showing symptoms of COVID-19, the Arts Academy will
  visitors to school
                                                                           follow the guidelines set for the by the Pennsylvania and
                                                                           Lehigh County Health Departments as well as the
Notifying staff, families, and the public of school closures               Pennsylvania Department of Education and the Office of the
and within-school- year changes in safety protocols                        Governor.
                                                                       •   Upon learning that a staff member or student is showing
                                                                           symptoms of COVID-19, that person(s) will be isolated in a
                                                                           designated space away from the rest of the school community
                                                                           in the building at that time. Those individuals will remain in the
                                                                           insolation room until they can be safely transported off
                                                                           campus. Symptomatic individuals will be referred to an
                                                                           appropriate health care provider for testing.
                                                                       •   The Arts Academy will await guidance from the Lehigh County
                                                                           and/or Pennsylvania Department of Health as to whether or
                                                                           not the symptomatic individual(s) will need to be quarantined.
                                                                       •   Lenient attendance polices will be put in place for students and
                                                                           staff that must be quarantined.

Other Considerations for Students and Staff

Requirement(s)                                                     Strategies, Policies and Procedures
* Protecting students and staff at higher risk for severe             • In the case of students and staff that are higher risk for
  illness                                                                 severe illness, the administration and nursing team will
                                                                          review each situation on a case by case basis. The
* Use of face coverings (masks or face shields) by all staff              school will work with the student and their family and,
                                                                          when appropriate, the individual’s health provider to
* Use of face coverings (masks or face shields) by older                  develop a plan that allows the student to access their
  students (as appropriate)                                               education while limiting risk to their health and safety.

                                                                                                                              Page 32 of 34
Requirement(s)                                            Strategies, Policies and Procedures
Unique safety protocols for students with complex needs      • As of July 1st, 2020, the Pennsylvania Department of
or other vulnerable individuals                                  Health is requiring that all individuals wear a face mask
                                                                 when they leave their homes. With this guidance in mind,
Strategic deployment of staff                                    all students, staff, and visitors will be required to wear a
                                                                 mask when they are in the school building. The Arts
                                                                 Academy Charter School will work with families of
                                                                 students that require accommodations to this directive.
                                                                 Similarly, administration will work with staff members that
                                                                 have difficulty following this directive because of a
                                                                 medical condition.
                                                             • In the case of students and staff that are higher risk for
                                                                 severe illness, the administration and nursing team will
                                                                 review each situation on a case by case basis. The
                                                                 school will work with the student and their family and,
                                                                 when appropriate, the individual’s health provider to
                                                                 develop a plan that allows the student to access their
                                                                 education while limiting risk to their health and safety.

                                                                                                                Page 33 of 34
Health and Safety Plan Governing Body Affirmation Statement
The Board of Directors/Trustees for (INSERT NAME OF LEA) reviewed and approved the
Phased School Reopening Health and Safety Plan on (INSERT DATE: MONTH, DAY, YEAR).

The plan was approved by a vote of:

                Yes

                No

Affirmed on: (INSERT DATE: MONTH, DAY, YEAR)

By:

(Signature* of Board President)

(Print Name of Board President)

*Electronic signatures on this document are acceptable using one of the two methods detailed below.

Option A: The use of actual signatures is encouraged whenever possible. This method requires that the
document be printed, signed, scanned, and then submitted.

Option B: If printing and scanning are not possible, add an electronic signature using the resident
Microsoft Office product signature option, which is free to everyone, no installation or purchase needed.

                                                                                           Page 34 of 34
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