TN Alliance Annual Reporting Form

TN Alliance Annual Reporting Form

Category IV Church-Related School
School Year*
Pursuant to Tennessee Code §49-501-801 all schools approved as church-related schools are required to provide the following information annually to the Tennessee Alliance for Church Related Schools (TN Alliance ) office. TN Alliance will take care of reporting the necessary information to the Tennessee State Department of Education.
School Name*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Phone*
Please enter a valid phone number.
School Fax
Please enter a valid phone number.
Contact Name*

First NameLast Name
Contact Email*
example@example.com
List the name and address of any accrediting association through which the school is accreddited or in which the school holds membership.
Name of Association 1
Association 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Association 1 Phone
Please enter a valid phone number.
Association 1 Fax
Please enter a valid phone number.
Name of Association 2
Association 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Association 2 Phone
Please enter a valid phone number.
Association 2 Fax
Please enter a valid phone number.
CERTIFICATION PURSUANT TO STATE BOARD RULE 0520-7-2-05

As administrator/principal of {schoolName} school, I certify that:
- {schoolName} complies with all rules and regulations and codes of the city, county and state regarding planning of new buildings, alterations and safety,
- {schoolName} complies with all rules and regulations of the Tennessee Department of Health and Environment regarding construction, maintenance and operation of the school plant,
- {schoolName} observes all fire safety regulations and procedures promulgated by the TN Fire Marshal's office,
- {schoolName} complies with the requirements of TCA §49-6-5001 that each child in the school be vaccinated against disease.
- {schoolName} complies with the requirement of TCA §49-6-3007 that the names, ages, and addresses of all pupils in attendance be reported to the superintendent of the public school system in which the student resides.
- {schoolName} complies with the requirements of TCA §49-6-104(a) and §49-6-201(b)(3) regarding the age requirement for students entering kindergarten and pre-kindergarten.
Authorized Name*

First NameLast Name
Title*
Signature*

Clear
Date

MonthDayYear
Date
Should be Empty: