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05-96-021 - Alaska Department of Education _ Early Development

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05-96-021 - Alaska Department of Education _ Early Development Powered By Docstoc
					                                                                         STATE OF ALASKA
                                                          DEPARTMENT OF EDUCATION & EARLY DEVELOPMENT
                                                                 BOARDING HOME PROGRAM REPORT
                                                                            4 AAC 09.050

Receiving District                                                                                              Fiscal Year
                                                    Column A          Column B            Column C              Column D                     Column E                     Column F
300 Pupil Support                                    Budget           Approved           Expenditures          Expenditures                 Expenditures                 Expenditures
                                                                       Budget            07-01 to 09-30       10-01 to 12-31               01-01 to 03-31                04-01 to 06-30
314 Placement Supervision*
426 Travel - Students
485 Student Stipends
            SUB-TOTALS
495 Indirect Costs ( Rate        %)
            TOTAL
TOTAL BUDGET FOR APPROVAL
STATE FUNDS FOR APPROVAL

Students - Beginning Count

* May not exceed 30% of stipend amount for students
attending outside their home district (4 AAC 09.050.4(c))

            ANNUAL APPLICATION AND BUDGET CERTIFICATION:                                                  QUARTERLY REIMBURSEMENT REQUEST:
            I certify that the students listed on the district's Individual
            Attendance and Boarding Home Reports meet the current
            eligibility requirements of 4 AAC 09.050. Primarily, those                                    I hereby certify that the funds in Column _____
            requirements are that: 1. Students are of secondary age, and                                  have been expended as shown.
            2. Students do not have daily access to a school of the appropriate
            grade level by being transported a reasonable distance.

            Superintendent or Certifying Official              Date                                       Superintendent or Certifying Official                   Date



APPROVED: (Completed by EED)

                            Program Administrator                                 Date                    School Finance Manager                           Date
    FORM# 05-96-021
    Alaska Department of Education Early Development
                                                                       STATE OF ALASKA
                                                        DEPARTMENT OF EDUCATION & EARLY DEVELOPMENT
                                                                INDIVIDUAL ATTENDANCE REPORT
                                                                          4 AAC 09.050
                                                                                                                                   Annual Budget
Receiving District                                                                                              1st Qtr. (7/1 - 9/30)            3rd Qtr. (1/1 - 3/31)
                                                                                                                2nd Qtr. (10/1 - 12/31)          4th Qtr. (4/1 - 6/30)

                                                                       EXPLANATION OF COLUMNS

1) Student name and village where parents reside                                               5) Date of entry into boarding home
2) Grade level (secondary students only)                                                       6) Date of termination from boarding home
3) Number of months and days claimed for BH stipend reimbursement                              7) Date of entry into school
4) Total stipends paid for period claimed                                                      8) Date of termination from school
                                                                                               9) Is student from out of your district? Yes/No
1. Student Name & Village                              2. Grade     3. Mo/Days   4. Stipends         5. BH            6. BH           7. School      8. School    9. Is student
                                                         Level        Claimed     /Period, $         DOE              DOT                DOE           DOT        out of district




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    FORM# 05-96-021
    Alaska Department of Education Early Development

				
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