School Configuration Update Form by HC120916193544

VIEWS: 2 PAGES: 11

									Request for School Directory and Accountability Status Changes
Due to a Merger, Split, New Grade Configuration, or Closure

Basic Information
District Code:                                       District Name:
School Code:                                         School Name:
Person Completing the form:
                                             First                    Last                   Title

This school is undergoing the following change for the year:                  Choose One

MERGER                               SPLIT                            NEW GRADE
                                                                      CONFIGURATION

Campus Location
1. Was the school building occupied by another                                 YES
school last year?
1a. Which school?                                                             School Code:
                                                                              School Code:
2. Will this school share a building next year?
                                                                              YES
2a. Which school?                                                             School Code:
                                                                              School Code:



Grade Configurations
Does this school currently enroll students?                                    YES
3a. What grades did this school serve last year?                                      PK             K
(circle all that apply)
3b. What was the October 1 enrollment last year?

3c. What grades does this school currently serve?                                     PK             K
(circle all that apply)
3d. What was the October 1 enrollment this year?

3c. Will this school enroll students in Choose One?                            YES
4. What grades will this school serve next year?                                      PK             K
(circle all that apply)
4a. What is the anticipated October 1 enrollment
 next year?
5. Is this school adding grade levels or                                       YES
otherwise expanding?
5a. When will this school be at full capacity?                                School Year:
5b. What is the anticipated October 1 enrollment
when the school will be at full capacity?                                     Enrollment:

Merger
6. Which schools and grade levels are merging?
                       School Code Merging Grades
Merging                            PK         K                           1                 2            3
Merging                            PK         K                           1                 2            3
Merging                            PK         K                           1                 2            3
Merging                            PK         K                           1                 2            3
New School                         PK         K                           1                 2            3
*This should include only the enrollment from the merging grade.

7. Which school(s) is the faculty of the newly merged school coming from?


                       School Code Number of Teachers
Merging
Merging
Merging
Merging
First year or out of
district teachers*

*This includes all teachers who are not currently employed by the district that will be staffing the merged school.


8. Which school(s) is the administration of the newly merged school coming from?


                       School Code Number of Administrators
Merging
Merging
Merging
Merging
First year or out of
district
administrators*
*This includes all administrators who are not currently employed by the district that will be staffing the merged school.



Split
9. Which grade levels from the original school will be served by the new schools?
                       School Code Name        Grades

Splitting                                      PK               K                           1            2
Splitting                                       PK                K                        1          2

New School                                      PK                K                        1          2

New School                                      PK                K                        1          2

New School                                      PK                K                        1          2

New School                                      PK                K                        1          2




10. What proportion of the faculty from the original school will staff the new schools??




                                                Number
                                                teachers from
                     School Code Name           original school Number of teachers from other schools or districts
Splitting
New School
New School
New School


11. Which school(s) is the administration of the newly merged school coming from?

                                                Number of
                                                administratorsf
                                                rom original
                     School Code Name           school          Number of administrators from other schools or districts
Splitting
New School
New School
New School



Closure
12. Which grades and students from the closing school will be served by the intake schools?

                     School Code Intake Grades*
Closing                              PK          K                        1                2          3
Intake School                        PK          K                        1                2          3
Intake School                        PK          K                        1                2          3
Intake School                        PK          K                        1                2          3
Intake School                        PK          K                        1                2          3
* For the closing school, please select all grades currently served.
**This should include only the enrollment from the intake grades.

13. What proportion of the faculty from the original school will staff the intake schools??
                     School Code Number teachers from closing school
Closing
Intake School
Intake School
Intake School
Intake School


14. What proportion of the administration from the original school will staff the intake schools??
                     School Code Number administrators from closing school
Closing
Intake School
Intake School
Intake School
Intake School
hanges




         CLOSURE




         NO (if no, skip to 2)

         School Code:
         School Code:

         NO
         School Code:
         School Code:




         NO (if no, skip to 4)
                1                2   3   4   5   6   7   8




                1                2   3   4   5   6   7   8




         NO
                1                2   3   4   5   6   7   8




         NO (if no, skip to …)
                            4   5   6   7   8   9   10   11
                            4   5   6   7   8   9   10   11
                            4   5   6   7   8   9   10   11
                            4   5   6   7   8   9   10   11
                            4   5   6   7   8   9   10   11




the merged school.




affing the merged school.




                            3   4   5   6   7   8    9   10
                           3    4   5   6   7   8    9   10

                           3    4   5   6   7   8    9   10

                           3    4   5   6   7   8    9   10

                           3    4   5   6   7   8    9   10

                           3    4   5   6   7   8    9   10




her schools or districts




om other schools or districts




                           4    5   6   7   8   9   10   11
                           4    5   6   7   8   9   10   11
                           4    5   6   7   8   9   10   11
                           4    5   6   7   8   9   10   11
                           4    5   6   7   8   9   10   11
9   10   11   12




9   10   11   12




9   10   11   12
     Enrollment*

12
12
12
12
12




                        Enrollment
11                 12
11              12

11              12

11              12

11              12

11              12




     Enrollment**

12
12
12
12
12

								
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