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									COUNT DAY ABSENCE FORM                                                                                    Elementary School
     District:                                                                                  School Year:                2009-2010

Building/Program:                                                                                 Count Day:               Sept.           Feb.


INSTRUCTIONS:                                                                                                          Form C

List each pupil absent on the count day. Note the grade of the pupil, the type of absence, and the date the pupil returned to school.
Determine the FTE based upon whether the pupil returned within the appropriate time frame.

                                                                                         Type of
                                                                                         Absence




                                                                                           (E)xcused or
                                                                                           (U)nexcused
                 Please list students alphabetically by grade.

                                                                                                                               FTE Membership
                            Name (Last, First, MI)                             Grade                       Date Returned          Reported
       Doe, Jane M.                                                              3rd           E               10/10                1.00
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.


I certify that this is a true and accurate list of all eligible FTE reported for pupils who were absent on the count day.



Authorized Representative                                                                                          Date



Title of Authorized Representative



DH:sh/Genesee ISD/6-15-04/Pupil Accounting/Forms 04-05/Countdayabsence(elem)




                                                                         D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsC - Count Day Absence
         None of our students are homebased due to district policy

                                                                                                                           Form K

SCHOOL YEAR:                                        2009-2010              SCHOOL DISTRICT:
COUNT DAY:                                      September 30, 2009         BLDG/PROGRAM:
SCHOOL CODE:                                                               BUILDING CODE:




School districts may count for membership those pupils educated in a home-based education
program (when expulsion is under district policy) as provided for expelled or suspended students under
Section 388.1606 (4)(u) State Aid Act. (Pupil Accounting Manual 5C-1)

The district may count the pupil in membership on a pro rata basis, with the proration based on the
number of hours of instruction the district actually provides to the pupil divided by 1098.
The district must provide at least 2 nonconsecutive hours of instruction per week.

INSTRUCTIONS

Complete the report below for all eligible pupils enrolled in a home-based education program who meet the
criteria noted above.

                                              DATE                                                                      PRO RATA
                                               OF               DATE              PUPIL                  GRADE             FTE
                PUPIL NAME                 EXPULSION          SERVICE         CLASSIFICATION             LEVEL         MEMBERSHIP
                                               OR              BEGAN              (Regular Ed /                         REPORTED
                                           SUSPENSION                              Special Ed)

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

                                                                                                      TOTAL FTE
The above pupils should appear on the building membership list and, if in special education, on the respective A or B
worksheet.

I certify this is a true and accurate list of eligible FTE reported for State aid.



Authorized Representative's Signature                                      Date



Title of Authorized Representative




                                                      D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsK - Homebased - District Policy
       None of our students are homebased due to mandatory expulsion

                                                                                                                          Form L

SCHOOL YEAR:                                        2009-2010             SCHOOL DISTRICT:
COUNT DAY:                                      September 30, 2009        BLDG/PROGRAM:
SCHOOL CODE:                                                              BUILDING CODE:




School districts may count for membership those pupils educated in a home-based education
program who were expelled pursuant to Revised School Code 380.1311 (2) or 380.1311a,
mandatory suspension or expulsion.

Pupils may be counted for a full membership providing all requirements are met - Pupil Accounting
Manual 5C-1.



INSTRUCTIONS

Complete the report below for all eligible pupils enrolled in a home-based education program who meet the
criteria noted in the Pupil Accounting Manual 5C-1.

                                              DATE
                                               OF              DATE              PUPIL                  GRADE            FTE
              PUPIL NAME                   EXPULSION         SERVICE         CLASSIFICATION             LEVEL        MEMBERSHIP
                                               OR             BEGAN              (Regular Ed /                        REPORTED
                                           SUSPENSION                             Special Ed)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

                                                                                                     TOTAL FTE
The above pupils should appear on the building membership list and, if in special education, on the respective A or B
worksheet.

I certify this is a true and accurate list of eligible FTE reported for State aid.



Authorized Representative's Signature                                     Date


Title of Authorized Representative




                                              D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsL - Homebased - Manditory Expul
                                                 HOMEBASED
                                         INSTRUCTIONAL SERVICE FORM
                                                                                                                  Form M

SCHOOL YEAR:                         2009-2010                   SCHOOL DISTRICT:
COUNT DAY:                       September 30, 2009              BLDG/PROGRAM :
SCHOOL CODE:                                                     BUILDING CODE:


INSTRUCTIONS
Complete the report below for each period of instruction provided to an eligible pupil enrolled in a homebased education
program. (Pupil Accounting Maual 5C-1)


           PUPIL

                            Homebased due to Mandatory Expulsion
                            Homebased due to District Policy Expulsion

    TEACHER(S)




                                                      INSTRUCTIONAL TIME                     ATTENDANCE
                           DATE
                                                 START                     END              ABSENT/PRESENT




                    Signature of Certificated Teacher


                    Date



                                                 D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsM - Homebased Teacher Log
          None of our students are enrolled in the homebound/hospitalized program.

                                                                                                                        Form N

SCHOOL YEAR:                         2009-2010                SCHOOL DISTRICT:
COUNT DAY:                       September 30, 2009           BLDG/PROGRAM:


School districts must provide homebound/hospitalized instructional services to an enrolled pupil who is
certified by the pupils attending physician, hospital, or licensed treatment facility as having a medical
condition that requires the pupil to be hospitalized or to be confined to the home during regular school
hours for a period longer than five school days. (Pupil Accounting Manual 5D-1)

School districts may count the student for one full FTE providing all requirements are met, including a
minimum of two 45-minute periods of instructional service per week for a regular education pupil, and
two one-hour nonconsecutive periods of instructional services per week for special education pupils
whose IEP calls for homebound/hospitalized services.
INSTRUCTIONS

Complete the report below for all eligible pupils enrolled in a homebound/hospitalized education program
who meet the criteria noted above.


                                               PHYSICIAN          DATE             PUPIL                                  FTE
                                                                                                       GRADE
              PUPIL NAME                      STATEMENT         SERVICE      CLASSIFICATION                           MEMBERSHIP
                                                                                                       LEVEL
                                                ON FILE          BEGAN      (Regualar/Special Ed)                      REPORTED


1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

                                                                                                    TOTAL FTE                          0
The above pupils should appear on the building membership list and, if in special education, on the respective A or B
worksheet.

I certify this is a true and accurate list of eligible FTE reported for State Aid.


Authorized Representative's Signature                                       Date


Title of Authorized Representative



                                                           D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsN-Homebound Hospitalized
                                      HOMEBOUND/HOSPITALIZED PUPILS
                                       INSTRUCTIONAL SERVICE FORM
                                                                                                                 Form O

SCHOOL YEAR:                         2009-2010                   SCHOOL DISTRICT:
COUNT DAY:                       September 30, 2009              BLDG/PROGRAM :
SCHOOL CODE:                                                     BUILDING CODE:


INSTRUCTIONS
Complete the report below for each period of instruction provided to an eligible pupil enrolled in a homebound/hospitalized
education program. (Pupil Accounting Maual 5D-1)


           PUPIL


    TEACHER(S)




                                                      INSTRUCTIONAL TIME                   ATTENDANCE
                           DATE
                                                 START                    END             ABSENT/PRESENT




                    Signature of Certificated Teacher


                    Date




                                                 D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsO-Homebound Teacher Log
         Our building has no nonpublic shared-time students.
                                                                                                                                                     Form T

SCHOOL YEAR:                                       2009-2010                              SCHOOL DISTRICT:
COUNT DAY:                                     September 30, 2009                         BLDG/PROGRAM:
SCHOOL CODE:                                                                              BUILDING CODE:


INSTRUCTIONS
List each nonpublic (including home-schooled) shared-time pupils who participated in your public school program. (Pupil Accounting Manual 5E-1)

                                                                                                                                TOTAL           TOTAL               FTE
     PUPIL                                        GRADE          COURSE                  MEETING                                DAYS OF         HOURS OF            MEMBERSHIP
     NAME                                         LEVEL          (Non-Core)              TIME / DAY                             INSTRUCT.       INSTRUCT.           REPORTED
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

FTE Calculation:                                                                                                                                TOTAL FTE
Minutes per Day X Days per Year
Hours/Year divided by 1098 equals Membership in FTE for One Pupil

I certify this is a true and accurate list of eligible nonpublic shared-time FTE memberships reported for State Aid.



Authorized Representative's Signature/Title                                               Date


Title of Authorized Representative

This form should be used for entire classes of nonpublic students educated at either the nonpublic school site or the public school site by a Certified teacher who is an employee of the public school
district.




                                                                                                                       D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsT - Nonpublic Shared Time
                                                    NONRESIDENTS UNDER STATE SCHOOL AID ACT SECTION 6 (6) (g) (assault) OR
                                                                SECTION 6 (6) (g) and (I) (MOVED)--RELEASE NOT REQUIRED.                                                             Form R


District:                                                                                                      School Year:                      2009-2010


Building/Program:                                                                                              Count Date:                       September 30, 2009

Instructions: Complete the following information for all nonresident pupils enrolled under Section 6 (6) (g) and (I).
                    Resident District                                       Pupil Name                                General Education Grade         Special Education Category       FTE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
                                                                                                                                                                         TOTAL FTE         -

I certify that this is a true and accurate list of eligible non-resident memberships reported for state aid.




                      Authorized Signature                                             Date




                                                                                                               D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsR - Non-Resident Sec 6(6)g
                                                                                NONRESIDENT STUDENTS

         District:                                                                                Building:                                   School Year:             2009-2010                      Form AA


                                                                                                              Check One                                                        Count              FTE
                                                                                                  105 C Spec
           Student Name                            Parent Name                 Grade    MAISD                                                      Resident District
                                                                                                   Ed Coop Choice 105c Release      Tuition                                 Sept.   Feb.   Gen. Ed.   Spec. Ed.
                                                                                        Choice
                                                                                                    Agmt




* For MAISD Auditing Purposes, completion of items with asterisks are optional, however, local districts may require information.




                                                                                                          D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsAA - Non Resident Students
D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsAA - Non Resident Students
          VERIFICATION OF SCHOOL OF CHOICE PARTICIPATION

                                                                              Form AB

SCHOOL YEAR:               2009-2010           SCHOOL DISTRICT:
COUNT DAY:             September 30, 2009      SCHOOL BUILDING:
SCHOOL CODE:                                   BUILDING CODE:




Our school complies with all the requirements and timelines of the following choice plan(s):




                   Muskegon County Choice Plan (in-county choice students)



                   Section 105C Choice Plan (out-of-county choice students)




Signature of Superintendent or Authorized Representative                 Date



Title of Authorized Representative
                                                           VERIFICATION STATEMENT
                                                                                                                             Form AC
School Year:                                   2009-2010                          School District:
Count Day:                               September 30, 2009                       Bldg/Program:
School Code:                                                                      Building Code:

1. All of our field trips counted as instruction time are educational trips supervised by certificated personnel and attendance is taken. Regular
   instruction is provided for those pupils who do not participate in an educational trip and attendance is taken.
2. Certificated personnel supervise all of our recess periods counted as instructional time.
3. A certified copy of each pupil's birth certificate has either been reviewed by district personnel or a copy had been filed in their enrollment file.
   enrollment file. Exceptions to this are indicated below.

We are in the process of obtaining birthdate documentation for the following new enrollees who were counted in memebership.

                                Pupil's Name                              Grade                                  Follow-up
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15



Authorized Representative's Signature                                    Title of Authorized Representative                Date
        None of our students are enrolled in the part-time program.
                                                                                                                         Form U

SCHOOL DISTRICT:                                                                SCHOOL YEAR:                           2009-2010
BLDG/PROGRAM:                                                                   COUNT DAY:                         September 30, 2009
BLDG CODE:                                                                      SCHOOL CODE:


INSTRUCTIONS
Complete the report below for all part-time pupils reported for pro rata FTE membership. (Pupil Accounting Manual 5F-1)



                                            Enrolled in two
                                                                                   Annual Hours of
                                               or more                                                   Full-Time        Pro Rata FTE
                Pupil Name                                    Other Districts     Instruction at this
                                              district's?                                                 Hours        Membership Reported
                                                                                       District
                                                  Y/N
1.Doe, Jane                                                                               549               1098                  0.5
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
                                                                                     TOTAL FTE



I certify this is a true and accurate list of part-time pupils reported for pro rata FTE membership.




Authorized Representative's Signature

Title of Authorized Representative                                                                                    Date




                                                              D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsU - Part-Time Pupils
        LEGAL RESIDENCE FOR PUBLIC SCHOOL MEMBERSHIP
                                                                                                                Form Z
Except as provided in Section 1711, a child placed under the order of direction of a court or child placing agency
in a licensed home, or a child whose parents or legal guardians are unable to provide a home for the child and
who is placed in a home of a relative in the school district for the purpose of securing a suitable home for the
child and NOT for an educational purpose, shall be considered a resident for education purposes of the
school district where the home in which the child is living is located. The child shall be admitted to the school in
the district.

                             STUDENT PLACED IN THE HOME OF A RELATIVE

                                                                being first duly sworn, deposes and says that he/she resides
                      (Name of relative)

at
                                                                (Address)

and is assuming physical custody of
                                                                                  (Name of Student)

who is a                                                                    of the relative.
                                     (Relationship)

The relative further says that it is necessary for said child to be placed as indicated above to establish a suitable
home for said child and that the placement is not for an educational purpose.


                                         (Signature of Relative)

                                                            , being first duly sworn, deposes and says that he/she
              (Parent or Legal Guardian)

resides at
                                                                    (Address)

The parent or legal guardian states that it is necessary for
                                                                                          (Name of Student)

to be placed as indicated above due to the following reason(s):




and such placement is not for an educational purpose.


Signature of Parent or Legal Guardian

Subscribed and sworn before me, a Notary Public, this                       day of

                        , A.D., in                              County.


Signature of Notary Public
******************************************************************************************************************************
       The                                                        school district, where the above parent of the child is a
resident, is aware of this matter and has been sent a copy of this notice.




                                                      D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsZ - Residency - Home of Relativ
                                              SPLIT-SCHEDULE PUPILS FORM
                                                                                                                             Form II
       This building has no split-schedule pupils.

SCHOOL YEAR                          2009-2010                SCHOOL DISTRICT
COUNT DAY                        September 30, 2009           SCHOOL BUILDING
SCHOOL CODE                                                   BUILDING CODE




INSTRUCTIONS
Complete the report below for all split-schedule pupils claimed for membership. You will need to use more than one
line for each pupil. (Pupil Accounting Manual 5M-1)

                                       FOR EACH PUPIL,
                                                            HOURS OF             TOTAL HOURS OF                        PRO RATA FTE
                                          LIST ALL                                                      FULL-TIME
             PUPIL NAME                                  INSTRUCTION AT         INSTRUCTION ALL                        MEMBERSHIP
                                         EDUCATING                                                        HOURS
                                                         EACH BLDG/PROG            BLDG/PROG                             CLAIMED
                                        BLDGS/PROGS


1                                                                                                          1098
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
                                                                                           Total FTE

I certify this is a true and accurate list of all split-schedule pupils claimed for membership.



Authorized Representative's Signature                                                                   Date


Title of Authorized Representative




                                                         D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsII - Split Schedule
                                                                                 Suspension & Explusion Log

      District                                                                   School Year                             2009-2010                                       Form JJ

      Building

                                      Student Name                                Suspension or       Mandatory or               List 1st and last   # of
  Date of Violation                     Last, First                      Grade     Expulsion*        District Policy**          date of suspension   Days                Reason
                                                                                                                                   or expulsion
                      1
                      2
                      3
                      4
                      5
                      6
                      7
                      8
                      9
                      10
                      11
                      12
                      13
                      14
                      15
                      16
                      17
                      18
                      19
                      20
                      21
                      22
                      23
                      24

* For suspensions: use S for home or IS for in-school.

** District Policy versus Mandatory: See Pupil Accounting Manual, Section 5N


Signature / Title of Authorized Representative                                                    Date




                                                                                                   D:\Docstoc\Working\pdf\6d9382b9-ab9a-4105-ae65-bd7b3f761ed5.xlsJJ- Suspension & Expulsion Log

								
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