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Currency [0]/Explanatory TextG5Explanatory Text % 0Good;Good  a%1 Heading 1G Heading 1 I}%O2 Heading 2G Heading 2 I}%?3 Heading 3G Heading 3 I}%234 Heading 49 Heading 4 I}%5( Hyperlink 6InputuInput ̙ ??v% 7 Linked CellK Linked Cell }% 8NeutralANeutral  e%"Normal 9Normal 2 :Noteb Note   ;OutputwOutput  ???%????????? ???<$Percent =Title1Title I}% >TotalMTotal %OO? Warning Text? Warning Text %XTableStyleMedium9PivotStyleLight16` KPg 1 }Pg 2 EPg 3 LPg 4 Pg 5 dPg 6 $Pg 7 !5Pg 8 EPg 9 WPg 10 mgPg 11 utPg 12 Pg 13 Pg 142   ;  ;9   ;3  ;  ;5  ;m   ;   ;   ;  ;  ;  ;  ; POSITION TITLEEMPLOYEE'S NAME Last, FirstTOTAL HRS PER WEEK+TOTAL HRS WORKED IN PRIVATE SCHOOL PER WEEKLIST ALL LICENSES HELD2(Months of employment) 10, 11 OR 12 MONTH EMPLOYEEHIGHEST DEGREE(S) HELD"(a) INSTRUCTIONAL PROGRAM VEHICLESMAKEMODELYEAR (b) NON-INSTRUCTIONAL VEHICLESRemarks:AddressAmount of Fiscal Year Rental17. If you answered item 13 with a yes, item (a) must be completed and/or if you answered item 14 with a yes, item (b) must be completed. For each vehicle, give the make, model, year, whether it is owned or leased, the plate number, is there personal usage of the vehicle (home to school commutation is considered personal use), was a mileage log maintained, does the vehicle have a car phone, and where the vehicle is maintained at night. All columns must be completed in order for the annual application to be considered complete.  PLATE NUMBERPERSONAL USE?* (Y/N)MILEAGE LOG (Y/N)CAR PHONE? (Y/N)WHERE IS VEHICLE MAINTAINED?$Less-Than- Arm s Length Yes NoName of ProgramType of Facility Own or RentTotal Square FootageLessor Name and AddressPeriod of Rental From - To%Effective Period of Rental From -- ToAmount of Fiscal Year Rental Item Rented-Less-Than-Arm s Length Transactions Yes or NoPRIVATE PLACEMENTIN STATE OUT OF STATEAutismTOTALS!2003-2004 TENTATIVE TUITION RATES(A) Ten MonthExtended(F)(B)(C)(D)(E)NameExecutive DirectorDirectorAsst. Director Bus. Manager PrincipalAssistant PrincipalAuditory ImpairmentsBehavioral DisabilitiesCognitive MildCognitive ModerateCognitive SevereMultiple DisabilitiesPreschool DisabilitiesVisual Impairments TOTAL PUPILS4Learning and/or Lang. Disabilities Mild to ModerateTYPE OF PROGRAM# OF CLASSESPUBLIC SCHOOL PUPILS*Learning and/or Lang. Disabilities Severe Enrolled Days Total RateTotal School Tuition RateFull Day Per Diem Rate I further certify that all professional staff are appropriately certified for the positions that they hold. I assure the Department of Education that all necessary health, safety, and necessary emergency procedures will be followed. It is further agreed that an end-of-year adjusted tuition rate will be determined by a certified audit report, which may involve an increase, or decrease in the projected tuition rate assigned this private school that, in turn, may involve refunds or additional charges to the sending public school districts.'(Signature Board President/Chairperson)(Signature Director in Charge)(print or type name)(date)[This affidavit must be executed before an individual authorized by law to administer oaths.Signature of Notary Public(Official Seal)Official TitleDEPARTMENT OF EDUCATIONMBy what other New Jersey agency(s) is your organization licensed or approved?If the school or agency reports to/or operates a holding company or other affiliate, list the name and address of the holding company or affiliate. If Profit:oIf school or agency is a non-profit corporation list the members of the Board of Directors or attach a listing:Commission for the Blind Department of HealthDepartment of Human ServicesDepartment of LaborOther Partnership1120 Corporation1120 S Corporation)Name of Corporate Auspices: (Check one)1.2.3.4.5.If any facilities are rented, please indicate for each location or each lessor listed, which of the following costs are included in the rent:Location or LessorHeatElectric and GasPeriodic PaintingAir Conditioning"Repairs and Maintenance - OrdinaryRepairs and Maintenance - MajorGrounds MaintenanceElevator Snow RemovalOther: (Please specify) 3If yes, please forward copies of the audit reports.hIf yes, indicate type of tax, to which governmental agency owed, the dollar amounts, and years involved./TaxAgencyAmountsYears6.7.NoYes (Is the school in arrears on any taxes? 8.LWere any personal or non-personal services donated to your agency or school?a./If personal services were donated, please list:b.,If other services were donated, please list:c.Donated Equipment:Type of EquipmentProgram ServedDollar Value of Service*Full-Time Equivalent of Donated PositionTitle of PositionDollar Value of Equipment9.10.6If yes, under what circumstances? The type of costs?Does the private school send any student(s) to a public school(s) for individual classes such as art? If so, please indicate the name of the course(s), the public school(s), and the cost to the private school.>If yes, please list destination(s) and frequency of transport: Destination Frequency9Do you bill third parties, such any insurance companies? 12.WIs transportation provided during the school day as part of the instructional program? 11.13.TTotal number of private placements (tuition paid by parent or other private source):CAn arm s length transaction means one entered into by independent and unrelated persons in a competitive transaction, between a willing buyer (lessee) and a willing seller (lessor). For this purpose, a less-than-arm s length transaction is one under which one party to the transaction is able to control or substantially influence the actions of the other. Such transactions are defined by the relationship of the parties and include, but are not limited to, those between divisions of an institution: institutions or organizations under common control through common officers, directors, or members; and an institution and a director, trustee, officer, or key employee of the institution or his/her immediate family either directly or through corporations, trusts, or similar arrangements in which they hold a controlling interest.LIs any property or equipment rented in a less-than-arm s length transaction? In-State:Out-of-State: 14.15.16.[Are costs for non-instructional vehicles included in the calculation of the tuition rate? Phone Number Fax NumberE-Mail Addressk(ACCOUNT #s 11-000-230-100, 11-000-240-103, 11-000-240-104, 11-000-240-105, 11-000-240-110, 11-000-290-100) Please designate the individual(s) that should receive all fiscal correspondence from the department by putting a (") check next to their name(s). If the title of the individual(s) is not indicated, you may add information in the blank spaces.stPlease briefly describe the programs your agency operates that are not funded through tuition payments from local school districts. Attach sheet if necessary.Profit:  Non-Profit: LLISTING OF GENERAL ADMIN, SCHOOL ADMIN, BUSINESS AND OTHER SUPPORT EMPLOYEESIF LEASED MONTHLY PAYMENTIF OWN PURCHASED PRICEVice Principal(ACCOUNTS #s 11-200-100-101, 11-200-100-104, 11-200-1< 00-106, 11-320-100-101, 11-320-100-106, 11-000-211.1-100, 11-000-213.1-100, 11-000-216-100, 11-000-222.1-101)*LISTING OF CLASSROOM INSTRUCTION EMPLOYEES%LISTING OF SUPPORT SERVICES EMPLOYEES(ACCOUNTS #s 11-000-211-100, 11-000-213-100, 11-000-218-104, 11-000-218-105, 11-000-218-110, 11-000-221-102, 11-000-221-104, 11-000-221-105, 11-000-221-110, 11-000-222-100, 11-000-222-101, 11-000-223-102, 11-000-223-104, 11-000-223-105, 11-000-223-110)EXTENDED SCHOOL YEAR PersonnelTEN MONTH SCHOOL YEAR tIf yes, indicate the property and/or equipment rented in a less-than-arm s length transaction on pages 13 and/or 14.}If yes, please complete section 17b, page 12 and provide a written explanation below, of the educational need for such costs.*If yes, please complete item 17a, page 12.I agree to cooperate with any Division of Family and Youth Services investigation into alleged child maltreatment; and if applicable, I will submit written corrective action plans in a timely manner, as per the remedial recommendations of that office. In the event that an appeal of the investigative finding is sought, I will immediately provide written notification to the Office of Special Education Programs.(F) FULL-TIME (P) PART-TIMEStarting Time: Ending Time:Length of School Day:Hrs.Date of Opening Day of School:Number of Days in Session:Type of School:Residential ___Email Address: Fax Number:County:Name of School:Address:Telephone Number:Summer Telephone #: This is to certify that1is a privately operated school and/or educationalor non-profitfacility and is profit making2organization providing non-sectarian services. It County of on thisState of&personally appeared before me the saidandday of: known to be the individuals described in and who executedthe foregoing instrument, and they duly acknowledge to me that they execute the same, and that the statements contained therein are true. Home to school and back to home. located atSchool Business Administrator Day ___ Assistant Bus. Manager0LIST ALL NEW JERSEY SCHOOL CERTIFICATION(S) HELD DOE ContactHas the Internal Revenue Service or any other government agency (Federal, State or Local) audited the school or parent organization within the last five (5) years?.PRIVATE SCHOOLS FOR STUDENTS WITH DISABILITIES%Employer Identification Number (EIN):TIf school or agency is for-profit, list names of owners and percentage of ownership:<S Date of Hire[is further certified that the program meets the standards of, and is conducted in full compliance with the Individuals with Disabilities Act, Section 504 of the Rehabilitation Act of 1973, and Title II and III of the Americans with Disabilities Act, P.L. 101-336, N.J.S.A. 18A:46-1 et seq., N.J.A.C. 6A:14 and N.J.A.C. 6A:23A-18.1 through 18.16. I hereby certify that all information submitted to the New Jersey Department of Education by the undersigned, is to the best of my knowledge accurate. It is further certified that all costs listed are directly attributable to the education of disabled children received from the public schools of New Jersey or private placements in the same classrooms with New Jersey public school children. It is further certified that the undersigned are aware of the non-allowable costs contained in N.J.A.C. 6A:23A-18.5 and that such costs charged as allowable costs in the private school for students with disabilities tuition rate are consistent with the Individualized Education Program of a disabled student and shall be reasonable, that is, ordinary and necessary and not in excess of the cost which would be incurred by an ordinary prudent person in the administration of public funds. It is also understood that the submission of erroneous and/or misleading information may lead to the prosecution by the ǿ޴ýapp./2012-2013 ANNUAL FISCAL AND PROGRAM INFORMATION2012-2013 ENROLLMENT 2012-2013AFFIDAVIT 2012-2013((A) TOTAL AGENCY SALARY 7/1/12 - 6/30/13((B) TOTAL SCHOOL SALARY 7/1/12 - 6/30/13((A) TOTAL AGENCY SALARY 7/1/12  6/30/13((B) TOTAL SCHOOL SALARY 7/1/12  6/30/13) 18. List the location of each program and administrative office which is associated with the private school for students with disabilities and governed by N.J.A.C. 6A:23A-18.1 through 18.16. All schools must complete this form. For each location give street address and building identification. Indicate whether the building is a school facility or administrative office, whether it is rented or owned and the total square footage per building either rented or owned. If the building is rented, list the name and address of each lessor, the effective period of the lease and the cost of the rental (for the fiscal year 7/01/12 - 6/30/13. If any property is rented in a less-than-arm s length transaction, please indicate in the appropriate column. Refer to #16 for an explanation of a less-than-arm s length transaction. All columns must be completed in order for the annual application to be considered complete. DO NOT LIST LOCATION(S) OF PROGRAMS THAT ARE NOT PART OF THE TUITION PROGRAM ASSOCIATED WITH THE PRIVATE SCHOOL FOR STUDENTS WITH DISABILITIES.[o<G  19. List the name and address of lessor(s), the type and cost of the rental of each and the effective period of the rental of any equipment and/or furniture associated with the private school for students with disabilities which is governed by N.J.A.C. 6A:23A-18.1 through 18.16. If any equipment or furniture is rented in less-than-arm s length transaction, please indicate in the appropriate column (for the fiscal year 7/01/12 - 6/30/13). Refer to #16 for an explanation of less-than-arm s length transaction. All columns must be completed in order for the annual application to be considered complete. DO NOT LIST LOCATION(S) OF PROGRAMS THAT ARE NOT PART OF THE TUITION PROGRAM ASSOCIATED WITH THE PRIVATE SCHOOL FOR STUDENTS WITH DISABILITIES.       c M* PLEASE ATTACH A COPY OF THE SCHOOL'S CALENDAR FOR THE 2012-2013 SCHOOL YEARK L \O8PzIQQRFR\S*Vl 3Wu YF Y tZQ[[-\|] _N/gqgkm]q{qrWsutWvu y|ccB  HWJR  dMbP?_*+%&L&F&C&"times,Regular"&9- &P -&?'?((\?)ffffff?M\\doeprintx1\2ad1hp41B5C5-F891?dXXLetter.HP LaserJet 4000 Series PCL 5e2xeOQ70Z@X`%FH` jb.P#H hH4FM+عq'~M1.~n^=iy<ۚ,3@$؝qɽqڈY Khy pf䅳OǠh}0[p^aE$- '\T[;'_ /kWKm68>$SV}k(|q} 7oߒ`hCUx :Nj|8\ƯXvC'ǵ=Y:yyka9YKnJZKXsP(ST^jl>)գjYԒ4VQf\ReP =sǂ j{mt>\rlv?e"aXX(\?q= ףp?&pcU} mA} A} $A} A}  A} A} $ AHI``@c c c *c c @ g@ @  Y0 Y0  @0@0@0@0@0@000@0@0@0@0@                   aaaaaa   n$ oooop ? 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Dl"""""""""""""""""""""""""""""""@ J A J B J C J D J E J F J G J H J I J J J K J L J M J N J O J P J Q J R J S J T J U J V J W J X J Y J Z J [ J \ J ] J ^ J _ J @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ Dl"""""""""""""""""""""""""""""""` J a J b J c J d J e J f J g J h J i J j J k J l J m J n J o J p J q J r J s J t J u J v J w J x J y J z J { J | J } J ~ J  J ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                 Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                 Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                 Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                 Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J   J   J   J   J   J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                      Dl"""""""""""""""""""""""""""""""  J ! J " J # J $ J % J & J ' J ( J ) J * J + J , J - J . J / J 0 J 1 J 2 J 3 J 4 J 5 J 6 J 7 J 8 J 9 J : J ; J < J = J > J ? J   ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? Dl"""""""""""""""""""""""""""""""@ J A J B J C J D J E J F J G J H J I J J J K J L J M J N J O J P J Q J R J S J T J U J V J W J X J Y J Z J [ J \ J ] J ^ J _ J @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ Dl"""""""""""""""""""""""""""""""` J a J b J c J d J e J f J g J h J i J j J k J l J m J n J o J p J q J r J s J t J u J v J w J x J y J z J { J | J } J ~ J  J ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                 Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                 Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                 Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                 Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J   J   J   J   J   J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                      Dl"""""""""""""""""""""""""""""""  J ! J " J # J $ J % J & J ' J ( J ) J * J + J , J - J . J / J 0 J 1 J 2 J 3 J 4 J 5 J 6 J 7 J 8 J 9 J : J ; J < J = J > J ? J   ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? Dl"""""""""""""""""""""""""""""""@ J A J B J C J D J E J F J G J H J I J J J K J L J M J N J O J P J Q J R J S J T J U J V J W J X J Y J Z J [ J \ J ] J ^ J _ J @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ Dl"""""""""""""""""""""""""""""""` J a J b J c J d J e J f J g J h J i J j J k J l J m J n J o J p J q J r J s J t J u J v J w J x J y J z J { J | J } J ~ J  J ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                 Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                 Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                 Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                 Dl""""""""""""""""""""""""""""""" J  J  J  J  J  J  J  J  J   J   J   J   J   J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J  J                                      Dl"""""""""""""""""""""""""""""""  J ! J " J # J $ J % J & J ' J ( J ) J * J + J , J - J . J / J 0 J 1 J 2 J 3 J 4 J 5 J 6 J 7 J 8 J 9 J : J ; J < J = J > ?   ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? Dl"""""""""""""""""""""""""""""" @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ Dl ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  Dl                                                                 Dl                                                                 Dl                                                                 Dl                                                                 Dl                                                                           Dl   ! " # $ % & ' ( ) * + , - . / 0 1 2   ! " # $ % & ' ( ) * + , - . / 0 1 2 *:h >@d777$ "   7I  Total Agency SalaryTotal Agency Salarywhole dollar values onlyNumeric entry onlyX e>AW=U Total School SalaryTotal School SalaryFwhole dollar entry only enter amount applicable to Private School only'Numeric entry whole dollar values only >AW=UmLPositionPosition enter position title of employeeText entry onlymoppW=ULEmployee's NameEmployee's Name'enter employee's name - last then firstText entry onlyUScW=U Full or Part TimeFull or Part TimeMake selection from list&Please drop down box to make selectionWF PPW=U Month of EmploymentMonths of EmploymentSelect entry from list+Please use drop down list box to enter textP10 11 12 ESY2W=U Total Hours Per WeekTotal Hours Per Week,Enter the number of hours worked by employeeNumeric entry required. 1? ES@N@W=U Total hours worked PSDTotal Hours work PSD .enter number of hours worked in private schoolnumeric entry required. ?<W=Uq LicensesLicenses"List all licenses held by employeeText entry onlyd ivdW= U  Degee*Please only list the highest degree held! VexSNone AA AS BA BS MS MA MBA Ed.D M.ED Ph.D JD MPT DPT BSN MSW Psy.D.=  Degee Degrees Held!List the highest degree held only8Please only enter the highest desgree held (1 degree). V SNone AA AS BA BS MS MA MBA Ed.D M.ED Ph.D JD MPT DPT BSN MSW Psy.D. O CertificationsList every certification held8le=gg@       !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcefghijklmnopqrstuvwxyz{|}~ R $,4<D#L*T1\8d?lFtM|T[bipw~lt|Ŀ $  dMbP?_*+%&L&F&L* All columns must be completed in order for this form to be complete. Please indicate NONE in columns 8, 9 and 10 for those individuals with no school certification, degree or license. &R- 5 -&?'?(ffffff?)zG?M\\doeprintx1\2ad1hp41B5C5-F891?dXXLetter.HP LaserJet 4000 Series PCL 5e2xeOOQ70ZA]h5D`h@taimGsq$KYʕOw.P佩6$s˻'MϳoD_9y3N1k¿«2Zx n O7+h}6x zZ}:"m9 NͶS},Z6x;`BXŮ׸sEw{C Eςy4EExzz 0 &x!qn,!Ɠ?Y_]S'2=ԪͰlVQ9Ock pݦJR}bn-4jp(*DneKΈÜg-, `e.u,e"_XX(\??&cU} A} A} $ A}  A}  A} A} A} A} A} A} A} $ A} IA} mA} IA} A} $ A D E ;;; ; ; ; ; ;;; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; B            C (BBBBBBBF?F@@6F@F@F@F@F @F"@F$@F&@ G H H H H H H H H  H  H  H                          Dl..:`""""""""""""""""""""""""" ;! ;" ;# ;$ ;% ;& ;' ;( ;) ;* ;+ ;, ;- ;. ;/ ;0 ;1 ;2 ;3 ;4 ;5 ;6 ;7 ;8 ;9 ;: ;; ;< ;= ;> ;? ; ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? Dl"""""""""""""""""""""""""""""""@ ;A ;B ;C ;D ;E ;F ;G ;H ;I ;J ;K ;L ;M ;N ;O ;P ;Q ;R ;S ;T ;U ;V ;W ;X ;Y ;Z ;[ ;\ ;] ;^ ;_ ;@ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ Dl"""""""""""""""""""""""""""""""` ;a ;b ;c ;d ;e ;f ;g ;h ;i ;j ;k ;l ;m ;n ;o ;p ;q ;r ;s ;t ;u ;v ;w ;x ;y ;z ;{ ;| ;} ;~ ; ;` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  Dl""""""""""""""""""""""""""""""" ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ;                                Dl""""""""""""""""""""""""""""""" ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ;                                Dl""""""""""""""""""""""""""""""" ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ;                                Dl""""""""""""""""""""""""""""""" ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ;                                Dl""""""""""""""""""""""""""""""" ; ; ; ; ; ; ; ; ;  ;  ;  ;  ;  ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ;                                     Dl"""""""""""""""""""""""""""""""  ;! ;" ;# ;$ ;% ;& ;' ;( ;) ;* ;+ ;, ;- ;. ;/ ;0 ;1 ;2 ;3 ;4 ;5 ;6 ;7 ;8 ;9 ;: ;; ;< ;= ;> ;? ;  ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? 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" # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? 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" # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ?   ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? Dl @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ Dl ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  Dl                                                                 Dl                                                                 Dl                                                                 Dl                                                                 Dl                                                                           Dl   ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < =  > ?   ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? Dl @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ Dl  ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  Dl                                                                 Dl                                                                 Dl                                                                 Dl                                                                 Dl                                                                           Dl   ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ?   ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? Dl @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ Dl ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  Dl                                                                 Dl                                                                 Dl                                                                 Dl                            >@d  $ "   7  Total Agency SalaryTotal Agency Salarywhole dollar values onlyNumeric entry onlyX e>ACA Total School SalaryTotal School SalaryFwhole dollar entry only enter amount applicable to Private School only'Numeric entry whole dollar values only >ACAmLPositionPosition enter position title of employeeText entry onlymoppCALEmployee's NameEmployee's Name'enter employee's name - last then firstText entry onlyAScCA Full or Part TimeFull or Part TimeMake selection from list&Please drop down box to make selectionCF PPCA Month of EmploymentMonths of EmploymentSelect entry from list+Please use drop down list box to enter textP10 11 12 ESY2CA Total Hours Per WeekTotal Hours Per Week,Enter the number of hours worked by employeeNumeric entry required. 1? ES@N@CA Total hours worked PSDTotal Hours work PSD .enter number of hours worked in private schoolnumeric entry required. ?<CAq LicensesLicenses"List all licenses held by employeeText entry onlyd ivdC A  Degee Degree Held9Please list the only highest degree held by the employee.8Please insert only one highest degree held per employee.V<SNone AA AS BA BS MS MA MBA Ed.D M.ED Ph.D JD MPT DPT BSN MSW Psy.D. O CertificationsList every certification helde ldgg@  lE MU]e&m-u4};BIPW^elsźՈݏ %-5=EMU]emu}#*18?FMT[bipw~ %-ŻͿ %-5=EMU]e mu} $(,048<@DHLPTX] aei%m-q5u=yE}MU]emu}Ž %-5=EMU] emu}  dMbP?_*+%&L&F&L* All columns must be completed in order for this form to be complete. Please indicate NONE in columns 8, 9 and 10 for those individuals with no school certification, degree or license. &R- 6 -&?'?((\?)?M HP LaserJet 4 Plus,C odXXLetterDINU",e SMTJHP LaserJet 4 PlusInputBinOption1RESDLLUniresDLLOrientationPORTRAITResolutionOption1PaperSizeLETTEREconomodeOption1RETOption1DuplexNONEHalftoneHT_PATSIZE_AUTO"_XX(\??&cU} } } $ }  }  } } } } } } } $ A   @      @  h@ h@ h@ h@ h@ h@ h@ h@ h@ h@ h@ h@ h@ h@ h@ h@ h@ h@ h@ Y@ Y@ Y@ Y@ Y@ Y@ Y@ B            C !!!!!!!!!!!B AAAAAAAACAA F?F@@6F@F@F@F@ @F"@F$@F&@ G H H H H H H H H  H  H  wwwwww  xxxxx  xxxxx  xxxxx  xxxxx  xxxxx  xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl... `""""""""""""""""""""""""" Y@! Y@" Y@# Y@$ Y@% Y@& Y@' Y@( Y@) Y@* Y@+ Y@, Y@- Y@. Y@/ Y@0 Y@1 Y@2 Y@3 Y@4 Y@5 Y@6 Y@7 Y@8 Y@9 Y@: Y@; Y@< Y@= Y@> Y@? Y@ xxxxx !xxxxx "xxxxx #xxxxx $xxxxx %xxxxx &xxxxx 'xxxxx (xxxxx )xxxxx *xxxxx +xxxxx ,xxxxx -xxxxx .xxxxx /xxxxx 0xxxxx 1xxxxx 2xxxxx 3xxxxx 4xxxxx 5xxxxx 6xxxxx 7xxxxx 8xxxxx 9xxxxx :xxxxx ;xxxxx <xxxxx =xxxxx >xxxxx ?xxxxx Dl"""""""""""""""""""""""""""""""@ Y@A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @xxxxx Axxxxx Bxxxxx Cxxxxx Dxxxxx Exxxxx Fxxxxx Gxxxxx Hxxxxx Ixxxxx Jxxxxx Kxxxxx Lxxxxx Mxxxxx Nxxxxx Oxxxxx Pxxxxx Qxxxxx Rxxxxx Sxxxxx Txxxxx Uxxxxx Vxxxxx Wxxxxx Xxxxxx Yxxxxx Zxxxxx [xxxxx \xxxxx ]xxxxx ^xxxxx _xxxxx Dl"""""""""""""""""""""""""""""""` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  `xxxxx axxxxx bxxxxx cxxxxx dxxxxx exxxxx fxxxxx gxxxxx hxxxxx ixxxxx jxxxxx kxxxxx lxxxxx mxxxxx nxxxxx oxxxxx pxxxxx qxxxxx rxxxxx sxxxxx txxxxx uxxxxx vxxxxx wxxxxx xxxxxx yxxxxx zxxxxx {xxxxx |xxxxx }xxxxx ~xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                     xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx  xxxxx  xxxxx  xxxxx  xxxxx  xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""  ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ?  xxxxx !xxxxx "xxxxx #xxxxx $xxxxx %xxxxx &xxxxx 'xxxxx (xxxxx )xxxxx *xxxxx +xxxxx ,xxxxx -xxxxx .xxxxx /xxxxx 0xxxxx 1xxxxx 2xxxxx 3xxxxx 4xxxxx 5xxxxx 6xxxxx 7xxxxx 8xxxxx 9xxxxx :xxxxx ;xxxxx <xxxxx =xxxxx >xxxxx ?xxxxx Dl"""""""""""""""""""""""""""""""@ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @xxxxx Axxxxx Bxxxxx Cxxxxx Dxxxxx Exxxxx Fxxxxx Gxxxxx Hxxxxx Ixxxxx Jxxxxx Kxxxxx Lxxxxx Mxxxxx Nxxxxx Oxxxxx Pxxxxx Qxxxxx Rxxxxx Sxxxxx Txxxxx Uxxxxx Vxxxxx Wxxxxx Xxxxxx Yxxxxx Zxxxxx [xxxxx \xxxxx ]xxxxx ^xxxxx _xxxxx Dl"""""""""""""""""""""""""""""""` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  `xxxxx axxxxx bxxxxx cxxxxx dxxxxx exxxxx fxxxxx gxxxxx hxxxxx ixxxxx jxxxxx kxxxxx lxxxxx mxxxxx nxxxxx oxxxxx pxxxxx qxxxxx rxxxxx sxxxxx txxxxx uxxxxx vxxxxx wxxxxx xxxxxx yxxxxx zxxxxx {xxxxx |xxxxx }xxxxx ~xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                     xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx  xxxxx  xxxxx  xxxxx  xxxxx  xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""  ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ?  xxxxx !xxxxx "xxxxx #xxxxx $xxxxx %xxxxx &xxxxx 'xxxxx (xxxxx )xxxxx *xxxxx +xxxxx ,xxxxx -xxxxx .xxxxx /xxxxx 0xxxxx 1xxxxx 2xxxxx 3xxxxx 4xxxxx 5xxxxx 6xxxxx 7xxxxx 8xxxxx 9xxxxx :xxxxx ;xxxxx <xxxxx =xxxxx >xxxxx ?xxxxx Dl"""""""""""""""""""""""""""""""@ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @xxxxx Axxxxx Bxxxxx Cxxxxx Dxxxxx Exxxxx Fxxxxx Gxxxxx Hxxxxx Ixxxxx Jxxxxx Kxxxxx Lxxxxx Mxxxxx Nxxxxx Oxxxxx Pxxxxx Qxxxxx Rxxxxx Sxxxxx Txxxxx Uxxxxx Vxxxxx Wxxxxx Xxxxxx Yxxxxx Zxxxxx [xxxxx \xxxxx ]xxxxx ^xxxxx _xxxxx Dl"""""""""""""""""""""""""""""""` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  `xxxxx axxxxx bxxxxx cxxxxx dxxxxx exxxxx fxxxxx gxxxxx hxxxxx ixxxxx jxxxxx kxxxxx lxxxxx mxxxxx nxxxxx oxxxxx pxxxxx qxxxxx rxxxxx sxxxxx txxxxx uxxxxx vxxxxx wxxxxx xxxxxx yxxxxx zxxxxx {xxxxx |xxxxx }xxxxx ~xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                     xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx  xxxxx  xxxxx  xxxxx  xxxxx  xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""  ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ?  xxxxx !xxxxx "xxxxx #xxxxx $xxxxx %xxxxx &xxxxx 'xxxxx (xxxxx )xxxxx *xxxxx +xxxxx ,xxxxx -xxxxx .xxxxx /xxxxx 0xxxxx 1xxxxx 2xxxxx 3xxxxx 4xxxxx 5xxxxx 6xxxxx 7xxxxx 8xxxxx 9xxxxx :xxxxx ;xxxxx <xxxxx =xxxxx >xxxxx ?xxxxx Dl"""""""""""""""""""""""""""""""@ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @xxxxx Axxxxx Bxxxxx Cxxxxx Dxxxxx Exxxxx Fxxxxx Gxxxxx Hxxxxx Ixxxxx Jxxxxx Kxxxxx Lxxxxx Mxxxxx Nxxxxx Oxxxxx Pxxxxx Qxxxxx Rxxxxx Sxxxxx Txxxxx Uxxxxx Vxxxxx Wxxxxx      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdeghijklmnopqrstuvwxyz{|}~ Xxxxxx Yxxxxx Zxxxxx [xxxxx \xxxxx ]xxxxx ^xxxxx _xxxxx Dl"""""""""""""""""""""""""""""""` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  `xxxxx axxxxx bxxxxx cxxxxx dxxxxx exxxxx fxxxxx gxxxxx hxxxxx ixxxxx jxxxxx kxxxxx lxxxxx mxxxxx nxxxxx oxxxxx pxxxxx qxxxxx rxxxxx sxxxxx txxxxx uxxxxx vxxxxx wxxxxx xxxxxx yxxxxx zxxxxx {xxxxx |xxxxx }xxxxx ~xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                     xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx  xxxxx  xxxxx  xxxxx  xxxxx  xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""  ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = , > ?  xxxxx !xxxxx "xxxxx #xxxxx $xxxxx %xxxxx &xxxxx 'xxxxx (xxxxx )xxxxx *xxxxx +xxxxx ,xxxxx -xxxxx .xxxxx /xxxxx 0xxxxx 1xxxxx 2xxxxx 3xxxxx 4xxxxx 5xxxxx 6xxxxx 7xxxxx 8xxxxx 9xxxxx :xxxxx ;xxxxx <xxxxx =xxxxx >xxxxx ?xxxxx Dl"""""""""""""""""""""""""""""""@ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @xxxxx Axxxxx Bxxxxx Cxxxxx Dxxxxx Exxxxx Fxxxxx Gxxxxx Hxxxxx Ixxxxx Jxxxxx Kxxxxx Lxxxxx Mxxxxx Nxxxxx Oxxxxx Pxxxxx Qxxxxx Rxxxxx Sxxxxx Txxxxx Uxxxxx Vxxxxx Wxxxxx Xxxxxx Yxxxxx Zxxxxx [xxxxx \xxxxx ]xxxxx ^xxxxx _xxxxx Dl"""""""""""""""""""""""""""""""` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  `xxxxx axxxxx bxxxxx cxxxxx dxxxxx exxxxx fxxxxx gxxxxx hxxxxx ixxxxx jxxxxx kxxxxx lxxxxx mxxxxx nxxxxx oxxxxx pxxxxx qxxxxx rxxxxx sxxxxx txxxxx uxxxxx vxxxxx wxxxxx xxxxxx yxxxxx zxxxxx {xxxxx |xxxxx }xxxxx ~xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                     xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx  xxxxx  xxxxx  xxxxx  xxxxx  xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""  ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ?  xxxxx !xxxxx "xxxxx #xxxxx $xxxxx %xxxxx &xxxxx 'xxxxx (xxxxx )xxxxx *xxxxx +xxxxx ,xxxxx -xxxxx .xxxxx /xxxxx 0xxxxx 1xxxxx 2xxxxx 3xxxxx 4xxxxx 5xxxxx 6xxxxx 7xxxxx 8xxxxx 9xxxxx :xxxxx ;xxxxx <xxxxx =xxxxx >xxxxx ?xxxxx Dl"""""""""""""""""""""""""""""""@ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @xxxxx Axxxxx Bxxxxx Cxxxxx Dxxxxx Exxxxx Fxxxxx Gxxxxx Hxxxxx Ixxxxx Jxxxxx Kxxxxx Lxxxxx Mxxxxx Nxxxxx Oxxxxx Pxxxxx Qxxxxx Rxxxxx Sxxxxx Txxxxx Uxxxxx Vxxxxx Wxxxxx Xxxxxx Yxxxxx Zxxxxx [xxxxx \xxxxx ]xxxxx ^xxxxx _xxxxx Dl"""""""""""""""""""""""""""""""` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  `xxxxx axxxxx bxxxxx cxxxxx dxxxxx exxxxx fxxxxx gxxxxx hxxxxx ixxxxx jxxxxx kxxxxx lxxxxx mxxxxx nxxxxx oxxxxx pxxxxx qxxxxx rxxxxx sxxxxx txxxxx uxxxxx vxxxxx wxxxxx xxxxxx yxxxxx zxxxxx {xxxxx |xxxxx }xxxxx ~xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                     xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx  xxxxx  xxxxx  xxxxx  xxxxx  xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""  ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ?  xxxxx !xxxxx "xxxxx #xxxxx $xxxxx %xxxxx &xxxxx 'xxxxx (xxxxx )xxxxx *xxxxx +xxxxx ,xxxxx -xxxxx .xxxxx /xxxxx 0xxxxx 1xxxxx 2xxxxx 3xxxxx 4xxxxx 5xxxxx 6xxxxx 7xxxxx 8xxxxx 9xxxxx :xxxxx ;xxxxx <xxxxx =xxxxx >xxxxx ?xxxxx Dl"""""""""""""""""""""""""""""""@ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @xxxxx Axxxxx Bxxxxx Cxxxxx Dxxxxx Exxxxx Fxxxxx Gxxxxx Hxxxxx Ixxxxx Jxxxxx Kxxxxx Lxxxxx Mxxxxx Nxxxxx Oxxxxx Pxxxxx Qxxxxx Rxxxxx Sxxxxx Txxxxx Uxxxxx Vxxxxx Wxxxxx Xxxxxx Yxxxxx Zxxxxx [xxxxx \xxxxx ]xxxxx ^xxxxx _xxxxx Dl"""""""""""""""""""""""""""""""` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  `xxxxx axxxxx bxxxxx cxxxxx dxxxxx exxxxx fxxxxx gxxxxx hxxxxx ixxxxx jxxxxx kxxxxx lxxxxx mxxxxx nxxxxx oxxxxx pxxxxx qxxxxx rxxxxx sxxxxx txxxxx uxxxxx vxxxxx wxxxxx xxxxxx yxxxxx zxxxxx {xxxxx |xxxxx }xxxxx ~xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                     xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx  xxxxx  xxxxx  xxxxx  xxxxx  xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""  ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ?  xxxxx !xxxxx "xxxxx #xxxxx $xxxxx %xxxxx &xxxxx 'xxxxx (xxxxx )xxxxx *xxxxx +xxxxx ,xxxxx -xxxxx .xxxxx /xxxxx 0xxxxx 1xxxxx 2xxxxx 3xxxxx 4xxxxx 5xxxxx 6xxxxx 7xxxxx 8xxxxx 9xxxxx :xxxxx ;xxxxx <xxxxx =xxxxx >xxxxx ?xxxxx Dl"""""""""""""""""""""""""""""""@ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @xxxxx Axxxxx Bxxxxx Cxxxxx Dxxxxx Exxxxx Fxxxxx Gxxxxx Hxxxxx Ixxxxx Jxxxxx Kxxxxx Lxxxxx Mxxxxx Nxxxxx Oxxxxx Pxxxxx Qxxxxx Rxxxxx Sxxxxx Txxxxx Uxxxxx Vxxxxx Wxxxxx Xxxxxx Yxxxxx Zxxxxx [xxxxx \xxxxx ]xxxxx ^xxxxx _xxxxx Dl"""""""""""""""""""""""""""""""` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  `xxxxx axxxxx bxxxxx cxxxxx dxxxxx exxxxx fxxxxx gxxxxx hxxxxx ixxxxx jxxxxx kxxxxx lxxxxx mxxxxx nxxxxx oxxxxx pxxxxx qxxxxx rxxxxx sxxxxx txxxxx uxxxxx vxxxxx wxxxxx xxxxxx yxxxxx zxxxxx {xxxxx |xxxxx }xxxxx ~xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""                                xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx xxxxx Dl"""""""""""""""""""""""""""""""      ,                           xxxxx xxxxx xxxxx xxxxx xxxxx                            DPl""""""                                                                 Dl                                                                            Dl   ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ?   ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? Dl @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ Dl ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  Dl                                                                 Dl                                                                 Dl                                                                 Dl                                                                 Dl                                                                 Dl  ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ?  ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? Dl @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ Dl ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | } ~  Dl                                                                 Dl                                                                 Dl                                                                 Dl                                                                 Dl                                                                 Dl  ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ?  ! " # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? 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