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Original Ink Signature
___________________
Date Signed
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Name of Chief Administrative Officer
(Please Type or Print)
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
This form is to be completed by approved private schools located in
New York State that provide special education services to students with
disabilities pursuant to Article 81 of the Education Law (not including Special
Act School Districts). Please designate a local education agency (LEA) from
whom to receive IDEA funds for students with disabilities provided special
education services pursuant to Article 81 of the Education Law and send the
completed form to the address in the letterhead and to the designated LEA,
by March 3, 2009.
In order to receive a sub-allocation of IDEA funds for 2009-2010 for students
with disabilities who are placed in your school by public school districts,
you must also complete a SEDCAR-1 form and send it to each school district that
placed students in your program as of October 1, 2008. The SEDCAR-1 form is
due to each school district by March 3, 2009.
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Instructions: |
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Section 1: Approved Private School
Program Information |
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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 | ||||||||||||
Section 2: Approved Private School Contact Person for Information |
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| NAME/TITLE | |
| TELEPHONE (Include Area Code) | FAX |
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IMPORTANT NOTE: This form must be received by the State Education Department and by the designated LEA, by March 3, 2009, in order to receive IDEA flow-through sub-allocations for the 2009-2010 school year. |
Section 3: Designated Local Education Agency Information |
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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 4: Status of Designated Local Education Agency |
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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. |
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A |
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| 1 | Continuation - The LEA designated for 2009-2010 was also designated for 2008-2009 | |
| 2 | Revision - The LEA designated for 2009-2010 is different than the LEA designated for 2008-2009 | |
| 3 | Initial - This is the first year in which an LEA has been designated by this approved special education program (ASEP) | |
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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
2009-10 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 2010-11 school year.
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Chief Administrative Officer Must Sign and Date |
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