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									M ILWAUKEE PUBLIC SCHOOLS ESEA Title Programs for Non-public Schools 5225 W . Vliet St r eet ; R oom 253, #11 Milwaukee, W isconsin 53208

2008-2009 Non-public School Title Program Request Form

Send this form as e-mail attachment to (Your School Name & words "Title Program Request" in subject line). Accompanying documentation may be emailed or mailed to MPS Central Services address above. Do not FAX request forms or documentation. Call 475-8122 or 475-8892 with questions.

School: Authorizing Administrator: Title contact name/email:

Phone/Ext Request Date Request #

By authorizing this request, I am indicating that I am an administrator who is authorized to approve Title Program requests for my school, and that I am fully informed about and agree to the following Title Program limitations on the use of materials located in a private school. Materials will be used for secular, nonideological purposes only. School personnel will be informed as to these limitations. Equipment and materials will supplement and not supplant the materials that, in the absence of Title Program funding, would have been made available for participating students. I agree to label all equipment and materials “Property of Milwaukee Public Schools ESEA Title Programs” and to maintain a log to indicate the inventory of Title Program property as well as the locations within the school where Title Program property is kept. Finally, I agree to periodic on-site monitoring from MPS personnel. Monitoring could include checks on uses of equipment and materials, discussions with private school officials, review of Title Program inventory or an audit of Title Program reporting. I understand that MPS, as the Local Educational Agency for local Title funds, must provide assurances that parents and staff members at participating schools will be involved in the development of annual school needs assessments, plans and evaluations of Title Program expenditures. Our school agrees to involve parents and staff to assess local needs, develop plans for expenditures, evaluate the effectiveness of our Title Programs and to share documentation related to these requirements upon request. Finally, I understand that expenditures may never be reimbursed directly to non-public schools or their sponsoring agencies and that non-public schools are responsible for financial commitments that exceed allocation limits or are denied based upon Title Program guidelines.

Title: Type: Justify/Explain: Location: Person/Entity to pay: Social Security # : Address: City, State, Zip: Phone: Unit Item or SS# Date(s):



Unit Price

Total Price $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 #REF!


Subtotal Shipping amount in Col. F (Required for purchases - if none, enter "none" in Col. E):



Grand Total #REF!


page 1 of 1, 11/28/2009

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