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APPROVED SPECIAL EDUCATION PROGRAM REQUEST FOR IDEA VENDOR FUNDING
FOR 2013-2014 SCHOOL YEAR

To view the description of the report including instructions please click here.

Section 1:  Approved Private School Program Information (Non-Special Act School District)
(Enter 12-digit SED Code Below)
Blank Boxes for SED Code
SCHOOL NAME

 

ADDRESS (include building name, room number, or mail stop information)

 


 

CITY

 

STATE

 

ZIP

 


Section 2 - Approved Private School Contact Person for Information
NAME/TITLE

 

TELEPHONE (include Area Code)

 

FAX

 


Section 2: Local Education Agency (LEA) Requested to Issue Vendor Funding. (For students placed in out-of-State schools by the courts or State agencies, the LEA is the school district in which the student resided at the time of such placement.)
(Enter 12-digit SED Code Below)
Blank Boxes for SED Code
LOCAL EDUCATION AGENCY NAME

 

ADDRESS (include building name, room number, or mail stop information)

 


 

CITY

 

STATE

 

ZIP

 



IMPORTANT NOTE: This form must be received by the State Education Department and by the designated LEA, by November 26, 2012, in order to receive IDEA flow-through sub-allocations for the 2013-2014 school year.

Section 3: Designated Local Education Agency Information
(Enter 12-digit SED Code Below)
Blank Boxes for SED Code
LOCAL EDUCATION AGENCY NAME

 

ADDRESS (include building name, room number, or mail stop information)

 


 

CITY

 

STATE

 

ZIP

 



Section 4: Status of Designated Local Education Agency
Please place a check in Column A in the appropriate line to indicate the status of the LEA designated by the Approved Special Education Program listed in Section 3.
    A
1 Continuation - The LEA designated for 2013-2014 was also designated for 2012-2013  
2 Revision - The LEA designated for 2013-2014 is different than the LEA designated for 2012-2013  
3 Initial - This is the first year in which an LEA has been designated by this approved special education program (ASEP)  

Certification and Assurances

The local education agency (LEA) listed in Section 3 is designated by this ASEP to be allocated additional IDEA Section 611 and Section 619 flow-through funds by the State Education Department, based on the December 1, 1998 count of students provided educational services pursuant to Article 81 of the Education Law, as reported to SED in the PD-2 report, adjusted by a population and poverty factor, for appropriate sub-allocation to this ASEP. I understand that the LEA designated in Section 3 will receive such additional IDEA funds for the 2013-14 year, and will continue to receive IDEA allocations for subsequent years, to be sub-allocated to this school, unless a revised form is submitted to SED for the designation of another LEA for the 2014-15 school year.

Form must be signed and dated by Chief School Administrative Officer. Please print out a printer friendly version of this form in Word or PDF.

Last Updated: November 25, 2013