The University of the State of New York
THE STATE EDUCATION DEPARTMENT
Office of Vocational and Educational Services for Individuals with Disabilities
(VESID)
Strategic Evaluation Data Collection, Analysis and Reporting (SEDCAR)
One Commerce Plaza - Room 1613
Albany, NY 12234-0001
The following types of schools must use this form to request vendor funding
of IDEA funds from school districts that have Committee on Preschool Special
Education (CPSE) or Committee on Special Education (CSE) responsibility for
students with disabilities:
Instructions: |
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Section 1: Approved Special Education Program Requesting Vendor Funding |
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(Enter 12-digit SED Code Below)
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SCHOOL NAME | ||||||||||||||
ADDRESS (include building name, room number, or mail
stop information) |
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CITY | STATE | ZIP |
Contact Person of Approved Special Education Program Requesting Vendor Funding |
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NAME/TITLE | |
TELEPHONE (Include Area Code) | FAX |
IMPORTANT NOTE: The LEA must receive this form by March 2, 2007, in order to provide vendor funding of IDEA funds to approved special education programs for the 2007-2008 school year. |
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.) |
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(Enter 12-digit SED Code Below)
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LOCAL EDUCATION AGENCY NAME | ||||||||||||||
ADDRESS (include building name, room number, or mail stop information | ||||||||||||||
CITY | STATE | ZIP |
Section 3: Child Counts, Pursuant to IDEA Sections 611
and 619, for Students Residing in LEA who is identified in Section 2.
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A | Students with disabilities, ages 3-4, on December 1, 2006 (please determine enrollment, age, and type of service provided as of December 1, 2006). Each student should be counted only once in either Line 1, 2 or 3. |
Count §611* |
Count §619* |
1 | Number of preschool students (ages 3-4) provided related services only. Do not report students in this line if they are also receiving other preschool special education programs. | ||
2 | Number of preschool students (ages 3-4) provided a preschool special education program, which includes Special Education Itinerant Teacher (SEIT) services and/or full or part-time special class or special class in an integrated setting services. These students may also be receiving related services. Please note that if students receive services from more than one provider, only the provider that is designated as the "coordinating provider" may report the student on this form. | ||
3 | Count of school-age students (ages 4-5) attending programs for school-age children. | ||
*Note: Students who are ages 3-5 are eligible to be counted under both Section 611 and Section 619 |
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B | Students with disabilities, ages 6-21, on December 1, 2006 (please determine enrollment and age as of December 1, 2006). |
Count §611* |
Count §619* |
1 | Count of students with disabilities, ages 6-21 | NA |
IDEA Section 619 flow-through funds are directed to students with disabilities, ages 3-5. Section 611 flow-through funds are directed to students with disabilities, ages 3-21.
Certification and Assurances |
I have reviewed the information reported in this form and
certify that this is a complete and accurate count of students with disabilities
who were placed in this program by the local education agency listed in Section
2 of this form, on December 1, 2006. I certify that such students placed in this
school were served in a manner consistent with their respective Individualized
Education Programs. A listing of the names of the students reported in Section 3
will be submitted to the local education agency with this form and marked
“confidential”.
__________________________ |
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Chief Administrative Officer Must Sign and Date |
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