PSA - Board Member Renewal Application

The Charter School Office at Grand Valley State University appreciates your interest to serve as a Public School Academy Board Member.

If you are approved to serve on an Academy Board, your role is to set policy, maintain the school's vision and/or mission, promote educational excellence through advocacy, visionary leadership, and high quality services to Grand Valley State University authorized public schools as well as to ensure that the school complies with its charter and applicable law.

All Academy board members are expected by GVSU to participate in board training offered by the university. Upon approval by the GVSU Board of Trustees, a board packet will be given to each newly appointed board member.

Academy board members are public officials appointed by the GVSU Board of Trustees. All potential GVSU School Board members are required to complete this application fully.

The GVSU Board of Trustees requires each Public School Academy Board nominee to undergo a personal background check. Applications will not be processed, nor will a name be submitted to the GVSU Board of Trustees, without the results from the personal background check.

* Denotes A Required Field

Personal Information


Your Name:






Address:











Recent Changes

Are there any changes from your last application that may influence your appointment?
If you selected yes, LIST ANY CHANGES FROM YOUR LAST APPLICATION THAT MAY INFLUENCE YOUR APPOINTMENT (Specifically list all changes to your Education History, Ages of your Children, Conflict of Interest and Ethical Matters *

You can download the original application here: New Board Member Application (PDF)

Application Verification

I recognize that all information submitted with this application or gathered by Grand Valley State University as a result of this application becomes a matter of public record, subject by law to disclosure upon request to members of the general public. I will hold Grand Valley State University, its trustees, officers, employees or authorized agents harmless from liability for the disclosure of any information it reasonably believes is true based upon my representations or resulting from this application process.

Please Note: Public School Academy Board Applications are subject to public disclosure under the Michigan Freedom of Information Act.

Personal Background Check Consent

A criminal records check must be conducted as a condition for appointment as a public official serving on the board of a public school academy authorized by Grand Valley State University. This consent does not authorize nor will Grand Valley State University conduct a consumer credit check.

Information requested on this page will be used to conduct a criminal records check and will not be used to determine qualifications as a proposed public school academy board member. This page will be removed prior to review of the information contained in the application.

Additional Information Needed for Background Check




Most Recent Former Address:





Gender: *

Ethnicity: *