2015-2016 Private School Data Form Instructions

2015-2016 Private School Data Form Instructions

1. Participation in consultation and affirmation processes applies only to non-profit private schools, including religious schools, that meet the state’s definition of an elementary or secondary school[1]. See OAR 581-015-2475 through 581-015-2483. Schools for 3 & 4 year olds must be in combination with any elementary grades, K-8.

DIRECTIONS:

Page 1 Directions

Enter the district name and Institution ID number. If a CONSORTIUM, enter the submitting agency name and Institution ID. For each private school, enter the following information:

(1)Institution ID number. Only private schools that are registered or approved will have a number, leave this field blank if there is no number.

(2)Private School Name. (Do not include specialized facilities such as corrections or detentions, long term care or treatment, hospitals, state schools, public alternative schools or public charter schools.)

Total enrollment on October 1st of all students ages 3-21 (not just special education students) parentally placed in private schools located in the district and a list of each private school in the district. Include enrollments for institutions who serve Pre-Kindergarten only, Kindergarten only, or any combination of grades.

(3)Telephone Number. Enter the telephone number of the private school.

(4)Enter the enrollment ofall private schools located in the district’s boundaries as of
October 1, 2015.

• Include all students age 3 – 12th grade, not just special education students.
• Exclude any students placed in a private school by public school districts.

NOTE: If a private school will not provide an enrollment figure, please note “Refused” after the name of the private school.

(5)Check the CONSULTATION PARTICIPANT box if theprivate school participated in the district consultation process for the 2015-2016school year.

Participation in consultation and affirmation processes applies only to non-profit private schools, including religious schools, that meet the state’s definition of an elementary or secondary school[2]. See OAR 581-015-2475 through 581-015-2483. Schools for 3 & 4 year olds must be in combination with any elementary grades, K-8.

(6)Enter the date that the consultation processoccurred.

(7)Check the LETTER OF AFFIRMATION box if the school submitted a written (signed) letter of affirmation to the district regarding the consultation that determined services for the 2015-2016school year.

(8) Total Enrollment (PK, Kindergarten and Grades 1-12 columns). Total the enrollment of all private schools listed. If completing the document on the computer, the form will auto-calculate totals.

(9)Review Certifications and complete Signature at the bottom of page 1.

If no private schools are located within the district, enter “No Private Schools within District Boundaries” and zero (0) in all three categories, review Certifications and complete Signature at the bottom of page 1 and page 2.

Page 2 Directions

Section I:Student population located within district.

First, complete Page 1 using directions above.

Item 1: Enter the total enrollment figure of all three columns from page 1. If completing the document on your computer, the form will auto-calculate this information.

Item 2: Enter the total number of eligible 3-5 year olds enrolled on December 1, 2014in public schools located in the district. This total must include children with disabilities enrolled in charter schools and public preschools.

Item 3: Enter the total number of eligible 6-21 year olds enrolled on December 1, 2014 in public schools located in the district.This total must include children with disabilities enrolled in charter schools.

 Item 4: Enter the total number of eligible parentally-placed 3-5 year olds enrolled in private elementary and pre-schools, including religious schools located in the district onDecember 1, 2014. (OAR 581-015-2475) This number should include all children ages 3-5 with disabilities eligible for services under IDEA and not just total served. It does not include students whose parents have revoked the special education services. OAR 581-015-2475 requires that the public agency conduct a timely and meaningful consultation process prior to identifying the number of these children.

Item 5: Enter the total number of parentally-placed 6-21 year olds enrolled in private elementary and secondary schools, including religious schools located in the district on December 1, 2014.(OAR 581-015-2475) This number should include all students with disabilities eligible for services under IDEA and not just total served. It does not include students whose parents have revoked the special education services. OAR 581-015-2475 requires that the public agency conduct a timely and meaningful consultation process prior to identifying the number of these children.

Section II: Calculation for Proportionate Share of IDEA Part B, Section 611 funds.

If completing the document on your computer, the form will auto-calculate items A, C, D and F.

Item A: Enter the sum of items 2, 3, 4 & 5 of section I above.

 Item B: Enter the gross total federal IDEA Part B, Section 611 funds awarded to school district for fiscal year 2015-2016. This amount is the total LEA gross amount before adjustments are made or funds removed for state programs. You can find the award information posted on ODE’s website at You can find additional information, in the Funding Q and A posted on ODE’s website at

Item C: Formula: Average allocation per eligible child. Divide the total of line B (the total allocation of IDEA Part B, Section 611) by Line A (total number of eligible children district-wide in private and public schools). (Formula: (B/A)).

Item D: This is the amount (proportionate share) of the current fiscal year grant that must be expended for parentally-placed children with disabilities. Multiply Line C (average allocation per eligible child) by lineItem 4 (total number of parentally-placed children ages 3-5 with disabilities) plus line Item 5 (total number of parentally-placed children ages 6-21). (Formula: D*(4+5)).

Item E: Prior year carry over. Enter the amount of unexpended proportionate share funds from the prior year. If none, enter 0.

Item F: Grand Total IDEA Part B, Section 611 proportionate share funds to expend, including previous year’s carry over funds. Add Line D(current fiscal year grant to be expended for parentally-placed children with disabilities) plus Line E(the prior year’s carry over). (Formula: D+E).

Section III: Calculation for Proportionate Share of IDEA Part B, Section 619 funds.

If completing the document on your computer, the form will auto-calculate items A, C, D and F.

Item A:Enter the sum of items 2 4 of section I above.

Item B: Enter the gross total federal IDEA Part B, Section 619 funds awarded to school district for fiscal year 2014-2015. This amount is the total LEA gross amount before adjustments are made or funds removed for state programs. You can find the award information posted on ODE’s website at You can find additional information, in the Finance Q and A posted on ODE’s website located at

Item C: Formula: Average allocation per eligible child. Divide the total of line B (the total allocation of IDEA Part B, Section 619) by Line A (total number of eligible children ages 3-5 district-wide in private and public schools). (Formula: (B/A))

Item D: This is the amount (proportionate share) of the current fiscal year grant that must be expended for parentally-placed children with disabilities. Multiply Line C (average allocation per eligible child) by line Item 4 (total number of parentally-placed children ages 3-5 with disabilities). (Formula: D*4).

Item E: Prior year carry over. Enter the amount of unexpended proportionate share funds from the prior year. If none, enter 0.

Item F: Grand Total IDEA Part B, Section 619 proportionate share funds to expend, including previous year’s carry over funds. Add Line D (current fiscal year grant to be expended for parentally-placed children with disabilities) plus Line E (the prior year’s carry over). (Formula: D+E).

Certifications: Read the certification statements. By signing the form the authorized official certifies this information on behalf of the district.

Signature

The form must be signed by an authorized official of the district (Superintendent, Business Manager, Special Education Director, or other official designated by the district) able to certify that allinformation reported on this form is valid: including a) the complete list of private schools located in the boundaries of the district; b) the notification of all private non-profit elementary and secondary schools located in the boundaries of the district regarding consultation and the availability of services for parentally-placed private school students pursuant to 34 CFR §§300.130-144, c) the receipt of letters of affirmation, and d) calculation of the proportionate share of IDEA funds to be expended.

mail completed form to:

Trish Lutgen

Office of Learning, Student Services Unit

255 Capitol Street NE

Salem, OR 97310-0203

Phone 503-947-5798

DO NOT FAX OR EMAIL

1

[1]Oregon defines an elementary school as “any combination of gradesK through 8.” In Oregon a preschool with kindergarten program and no otherelementary grades is not considered an elementary school. "High School" is defined as any combination of grades 10 through 12 in districts providing a junior high school containing grade 9; any combination of grades 9 through 12 organized as a separate unit; grades 9 through 12 housed with grades K through 12; grades 7 or 8 through 12, if approved by the Oregon Department of Education. OAR 581-022-0102

[2]Oregon defines an elementary school as “any combination of gradesK through 8.” In Oregon a preschool with kindergarten program and no otherelementary grades is not considered an elementary school. "High School" is defined as any combination of grades 10 through 12 in districts providing a junior high school containing grade 9; any combination of grades 9 through 12 organized as a separate unit; grades 9 through 12 housed with grades K through 12; grades 7 or 8 through 12, if approved by the Oregon Department of Education. OAR 581-022-0102