ࡱ> c Gbjbj ;W\W\>/R R 4hfd<3(DDDD3F3F3F3F3F3F3$}538j3x"x"x"j3DD3)))x"FDDD3)x"D3))V/@D0DF"F/ 03303/x8#48D0D08X0:Y)9j3j38&3x"x"x"x"8R > :  PRIVATE SCHOOLS FOR STUDENTS WITH DISABILITIES 2017 - 2018 NEW SCHOOL BUDGET APPLICATION DIRECTIONS FOR COMPLETING THE NEW SCHOOL APPLICATION 7/1/2017 to 6/30/2018 PROJECTED BUDGET 1. Private school tuition rates will be based on one per diem rate for the July through June school year. The same per diem rate must be charged for all pupils regardless if the pupil attends only the ten month school year, or only the extended school year, or both the ten month and extended school years and if the pupil enrolls after the start of the ten month or extended school years. This budget document is for the July through June school year and the tuition rate is based on a per diem rate using an average daily enrollment (ADE) for the 12 month school year. 2. Insert the requested information on pages one through three. The Projected Average Daily Enrollment on page 1 is now based on an ADE for the 12 month school year. If a school has only a ten month school year for 180 days, the projected ADE would be based on the number of pupils enrolled for the entire ten month school year. If the school has both a ten month school year for 180 days and extended school year for 30 days, the projected ADE for all pupils would be based the total enrolled days of 210. In this case, a pupil in the ten month and extended school years would be 210/210 or 1.0, a pupil in just the ten month school year would be 180/210 or 0.8571 and a pupil in only the extended school year would be 30/210 or 0.1428. On page 1, the Total Projected Average Daily Enrollment line, columns 1, 2 and 3 must equal column 4. Public School ADE is the July through June average daily enrollment for pupils whose tuition is paid by a New Jersey school district or New Jersey state agency. Private Placements In-State ADE is the July through June average daily enrollment for pupils who reside in New Jersey whose tuition is paid by a parent, guardian or the private school is supporting the cost of the pupils education through another funding source. Private Placement Out-of-State ADE is the July through June average daily enrollment for pupils who reside in a state other than New Jersey whose tuition is paid by a parent, guardian, an out-of-state public school, a state agency of a state other then New Jersey or the private school is supporting the cost of the pupils education through another funding source. In accordance with N.J.A.C. 6A:23A-18.4(b)2, the applicant shall document the need for a minimum of 24 public school placement students in order to be approved by the Commissioner. In accordance with N.J.A.C. 6A:23A-18.4(c)1, the school shall receive preliminary approval to operate for a two year period, after which the school shall provide documentation that the school has a minimum ADE of 24 public school placement students by the end of the second school year; in accordance with N.J.A.C. 6A:23A-18.4(c)1i, a school meeting the minimum ADE of 24 public school placement students by the end of the second school year shall receive new school approval; and in accordance with N.J.A.C. 6A:23A-18.4(c)1ii, a school not meeting the minimum ADE of 24 public school placement students by the end of the second school year shall have its preliminary approval status revoked and shall no longer be considered an approved private school for students with disabilities. Approved private schools for students with disabilities operating in and affiliated with a public school are exempt from N.J.A.C. 6A:23A-18.4(b)1, (c)1i, ii, iii, iv, v, and vi. Insert the name of the school at the top of page 4 on the line titled Name of School. Insert on pages 19 through 40, by title of position, the projected salary by individual for the 7/1/2017 to 6/30/2018 school year (no names). The totals by category from pages 19 through 40 will be inserted on the lines and page numbers indicated at the bottom of each salary analysis. For example, the total of Special Education - Instruction - Cognitive Mild - Salaries of Teachers will automatically be inserted on line 3500, page 4; the total of Undistributed Expenditures Support Services School Administration Salaries of Principals/Assistant Principals will be automatically inserted on line 46000, page 12, etc. If additional space is needed, please insert the appropriate number of rows in each account title as needed. Insert expenditures, other than salaries, by account title on pages 4 through 16 in column (E) Budgeted Expenditures. In accordance with N.J.A.C. 6A:23A-18.3(a)1, when determining the actual allowable costs for the program, the board of directors shall ensure that such costs are based on all costs required for student instruction from July 1 through June 30, consistent with the students individualized education programs (IEP), and inclusive of all costs required to implement all students' IEPs and all related services, reasonable, that is ordinary and necessary and not in excess of the cost that would be incurred by an ordinarily prudent person in the administration of public funds, and based on goods actually received and placed in service and/or services rendered in the fiscal year expensed. In accordance with N.J.A.C. 6A:23A-18.3(a)5, the private school shall not bill the sending district board of education separately for related services that are required by a student's initial or subsequent IEP with limited exception. If the related service required by an IEP is beyond what is typically provided during the school day, or the nature of the related services requires that it be beyond the school day/ operating hours, the APSSD may address the costs and provision of such related services through a separate agreement with the sending district. The line items by category will be summed and inserted at the end of each category on pages 4 through 16. For example, the sum of lines 3500 through 3640 will be inserted on line 3660 in column (E) Budgeted Expenditures on page 4, the sum of lines 4700 through 4860 will be inserted on line 4880 in column (E) Budgeted Expenditures on page 5, etc. The grand total of each category will be inserted on line 90000, page 16. The totals by category from pages 4 through 16 will be transferred to the Budget Summary on page 17 on lines 3660 through 89980. The totals on lines 3660 through 89980 will be summed and the total will be inserted on line 90000, Total Budgeted Expenditures. Please note that costs associated with Extraordinary Services will be excluded from the total budgeted expenditures and the tuition rate calculation as these costs are not permitted in accordance with N.J.A.C. 6A:23A-18.1 et seq. The Total Budgeted Expenditures from page 17, line 90000 will be inserted on page 18, line 13 to determine the maximum Working Capital / Surcharge. The Total Budgeted Expenditures on line 13 is multiplied by 0.025 and the result is inserted on line 15, page 18. Line 15 on page 18, will be inserted on line 2. The school has the option of including a Working Capital / Surcharge of an amount equal to or less than 2.5% of the Total Budgeted Expenditures but the amount included is a management decision. A school is not required to include a Working Capital / Surcharge in the Budgeted Per Pupil Tuition Rate. The Total Budgeted Expenditures from page 17, line 90000 will be inserted on page 18, line 1. The Total Budgeted Expenditures from line 1 and Working Capital / Surcharge from line 2 will be summed and the total will be inserted on line 3. This is the Total Budged Expenditures and Working Capital / Surcharge. Insert the Estimated Average Daily Enrollment (ADE) on page 18, line 4. This ADE is based on a July1st through June 30th school year. If a school has only a ten month school year for 180 days, the Estimated ADE would be based on the total number of enrolled days for all pupils for the ten month school year divided by 180. If the school has both a ten month school year for 180 days and extended school year for 30 days, the Estimated ADE for all pupils would be based on the total number of enrolled days for all pupils (both ten month and extended) divided by 210. In this case, a pupil enrolled in the ten month and extended school years would be 210/210 or an ADE of 1.0, a pupil enrolled in just the ten month school year would be 180/210 or an ADE of 0.8571 and a pupil enrolled only in the extended school year would be 30/210 or an ADE of 0.1428. The Total Budgeted Expenditures and Working Capital / Surcharge on page 18, line 3 will be divided by the Estimated ADE on line 4. The total will be inserted on line 5. This is the 7/1/2017 to 6/30/2018 Budgeted Per Pupil Tuition Rate the school is planning to charge for the July 1st to June 30th school year. Insert the Total Number of Days in Session for the period of July 1st to June 30th on page 18, line 6. The 7/1/2017 to 6/30/2018 Budgeted Per Pupil Tuition Rate from line 5 will be divided by the total number of days in session for the period of July 1st to June 30th from line 6 and the total will be inserted on line 7. This is the Budgeted Per Diem Tuition Rate the school is planning to charge. The same per diem rate must be charged for pupils enrolled in the ten month school year and the extended school year. To determine the Ten Month School Year Tuition Rate (September through June), insert the number of enrolled days for the Ten Month School Year on page 18, line 8. This number must be a minimum of 180 days. The number of enrolled days for the Ten Month School Year on line 8 will be multiplied by the Budgeted Per Diem Tuition Rate on line 7 and the total will be inserted on line 9. This is the Total Ten Month School Year Tuition Rate. To determine the Extended School Year Tuition Rate (July through August), if applicable, the Budgeted Per Diem Tuition Rate from page 18, line 7 will be inserted on line 10. Insert the number of enrolled days for the Extended School Year on line 11. The Budgeted Per Diem Tuition Rate from line 10 will be multiplied by the enrolled days for the Extended School Year from line 11 and the total will be inserted on line 12. This is the Total Extended School Year Tuition Rate. Please return pages 1 through 40 to the Department of Education and retain a copy for your files. Forward the budget via email to  HYPERLINK "mailto:doe.pssd@doe.state.nj.us" doe.pssd@doe.state.nj.us or via mail to the following address: Elise Sadler-Williams, Planning Associate NJ State Department of Education Division of Finance Office of School Finance Fiscal Policy & Planning P. O. Box 500 Trenton, New Jersey 08625-0500 PRIVATE SCHOOL FOR STUEENTS WITH DISABILITIES NEW SCHOOL BUDGET 7/1/2017 to 6/30/2018 NAME OF SCHOOL: COUNTY: ADDRESS: TELEPHONE NUMBER: FAX NUMBER: SUMMER TELEPHONE NUMBER: E-MAIL ADDRESS: PROJECTED AVERAGE DAILY ENROLLMENT JULY THROUGH JUNE (1)(2)(3)(4)(5)PROGRAM TYPEPUBLIC SCHOOL PUPILS ADEPRIVATE PLACEMENTS IN STATE OUT OF STATE ADE ADETOTAL PUPILS ADE# OF CLASSESAuditory ImpairmentsAutismBehavioral DisabilitiesCognitive MildCognitive ModerateCognitive SevereLearning and/ or Lang. Disability Mild to ModerateLearning and/ or Lang. Disability SevereMultiple DisabilitiesPreschool DisabilitiesVisual DisabilitiesTOTAL PROJECTED ADE TEN MONTH PROGRAM EXTENDED SCHOOL YEAR PROGRAM Date of Opening Day of School: _______________ Date of Opening Day of School: _______________ Number of Days in Session: __________________ Number of Days in Session: __________________ Length of School Day: ______ Hrs. Length of School Day: ________ Hrs. Starting Time: ___________________ Starting Time: ___________________ Ending Time: ____________________ Ending Time: ____________________ Type of School: Day ___ Residential ___ Type of Organization: Nonprofit Profit Administrative Personnel NAME FAX NumberPhone Number E-Mail Address Director     Assistant Director    Executive Director    School Business Administrator Business Manager    Principal    Assistant Principal    Vice Principal    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. STATE OF NEW JERSEY DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION PROGRAMS DIVISION OF FINANCE AFFIDAVIT CERTIFYING THAT DAY CLASSES IN A PRIVATE SCHOOL ARE NON-SECTARIAN IN COMPLIANCE WITH THE RULES AND REGULATIONS OF THE NEW JERSEY STATE BOARD OF EDUCATION PURSUANT TO TITLE 18A:46 NEW JERSEY STATUTES ANNOTATED. AFFIDAVIT* This is to certify that _________________________________________________________________ located at __________________________________________________________ is a privately operated school and/or educational facility and is profit making ____ or non-profit ____ organization providing non-sectarian services. It is further certified that the program meets the standards of and is conducted in full compliance with the Rules and Regulations of the New Jersey State Board of Education adopted pursuant to N.J.S.A. 18A:46, N.J.A.C. 6A:23A-18.1 through 18.23, N.J.A.C. 6A:14 et seq., 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. 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 understood that the submission of erroneous and/or misleading information may lead to the prosecution by the ǿ޴ýapp. I further certify that all professional staff are appropriately certified for the positions, which 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, which, in turn, may involve refunds or additional charges to the sending public school districts. 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 appeal of the investigative finding is sought, I will immediately provide written notification to the Office of Special Education Programs. (Signature Board President/Chairperson)(Signature Director in Charge) (Print or type name) (Date)(Print or type name) (Date)This affidavit must be executed before an individual authorized by law to administer oaths. State of ________________________________ County of ______________________________ on this _____ Day of _______________, 20___ personally appeared before me the said ___________________________ and _____________________________ known to be the individuals described in and who executed the foregoing instrument, and they duly acknowledge to me that they execute the same, and that the statements contained therein are true. _________________________________________ Signature of Notary Public (Official Seal) _________________________________________ Official Title     -  PAGE 3 - -  PAGE 1 -  %&8>ABHIN[gijopqrsvwx] yri`ihh aJhhW-zaJ hhW-z h`eZ5>* hb5>* hUHO5>*hhW-z5>*hhW-z\aJ hah\aJ hW-zCJhW-zCJ(PJhW-z5CJ$\h`eZ5CJ(\hb5CJ(\hUHO5CJ(\h6:5CJ(\hN=5CJ(\hW-z5CJ(\ hW-zCJ(hW-z$ &9;<=>Jijklmnopqrs$a$$a$ !stuvwx  jk\] h^h`gd_ & F h^hgd_ $h^ha$gdh $h^ha$gdh h^h` h^h`$a$$a$]  * L U Z  >BTbfghklno_CDEGILMR%6PSӽ˯ӤϤϠӤϤϠӑhN=h5ly h5lyh1Ifhp4Nh) h5lyh yh$D h5lyh h5lyh>y h5lyhi h5lyhlhh/ 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