PRIVATE SCHOOLS SERVING CHILDREN IN ATTENDANCE AREAS WHERE. P.L. 81-874
(TITLF. I ACTIVITIES WILL BE LOCATED

U Regular Summer School

TOTAL NUMBER OF CHILDREN ESTIMATED NO. OF CHILDREN
NAME OF PARTICIPATING PRIVATE

GRADE
ENROLLED IN EACH SCHOOL

WHO WILL PARTICIPATE IN
SPAN
LISTED IN COLUMN (1)

ACTIVITIES AT SCHOOLS LISTED
SCHOOLS

IN COLUMN (1)
TIT

713)

TOTAL

ESTIMATED NUMBER OF PARTICIPATING CHILDREN BY GRADE LEVEL AND TYPE OF SCHOOL

с

ESTIMATED NUMBER OF HANDICAPPED CHILDREN, INCLUDED IN ITEM 12A, WHO WILL PARTICIPATE IN ACTIVITIES DESIGNED
SPECIFICALLY FOR HANDICAPPED CHILDREN (Report each child once by major handicap).
MENTALLY HARD OF

DEAF

SPEECH VISUALLY SERIOUSLY CRIPPLED OTHER TOTAL
RETARDED HEARING
IMPAIRED HANDICAPPED EMOTIONALLY

HEALTH
DISTURBED

IMPAIRED

Effective July 20, 1976

ESTIMATED TOTAL AMOUNT

(62

(Sum of lines 1 . 11a) SUBTOTAL

(Sum of lines 13 thru 17, Col. 6) SUB-TOTAL

TOTAL PROJECT BUDGET (Sum of lines 12 and 18)

TOTAL SALARIES

(6)

P.L. 81-874

VII.

(7)

(8)

INSTRUCTIONAL ACTIVITIES AND RELATED SUPPORTIVE SERVICE TO BE FUNDED UNDER P.L. 61-874.
(TITLE I) NO. OF CHILDREN AND ESTIMATED COST.

CHECK ONE TO IDENTIFY THE SCHOOL TERM BEING REPORTED ON: [/Regular [] Summer School A INSTRUCTIONAL ACTIVITIES

ESTIMATED NO. OF CHILDREN WHO WILL PARTICIPATE
IN INSTRUCTIONAL ACTIVITIES LISTED IN COL. (1)

ESTIMATED COST

OF EACH INST.
INSTRUCTIONAL ACTIVITIES
PUBLIC SCHOOL PRIVATE SCHOOL

NO. IN COL. 6 ACTIVITY

TOTAL
CHILDREN

(ROUNDED TO CHILDREN

FROM INSTI (SUM OF

TUTIONS FOR NEAREST DOLLAR)

COL'S.
GAS. 1-6 GRS. 7-12 GRS. 16 GRS. 7-12

NEG. OR DEL.

(See Instructions) 2 THRU 5)

CHILDREN
(2)

(3)
(4)
(5)

(6)
Kindergarten
2 Reading
3 Mathematics

Other (Specity)
5 Speech Thorapy
6. Special Act, for Handicapped
7 Other (Specify)
8 Other (Specify)
9 Other (Specify)
10 Other (Specify)
u Other (Specify)
12 Other (Specify)

4

B

20 TOTAL ESTIMATED COST FOR INSTRUCTIONAL ACTIVITIES (SUM OF LINES 13A. 1 THRU 12)
SUPPORTIVE SERVICES
ESTIMATED NUMBER OF CHILDREN WHO WILL PARTICIPATE IN SERVICES

ESTIMATED

NO. IN COL. 7
KIND.

COST OF EAC!
PUBLIC SCHOOL PRIVATE SCHOOL TOTAL

FROM INSTI-
SUPPORTIVE SERVICES

CHILDREN

SERVICE CHILDREN (PUB

(SUM OF

TUTIONS FOR ACTIVITY

COLS.
&

NEG. OR DEL.
PRI.)

(ROUNDED TO GRS. 1-6

2 THRU 6) GRS. 7-12 GRS. 1-6 GRS. 7-12

CHILDREN NEAREST DOLLAR)

TOTAL ESTIMATED COST FOR ALL INSTRUCTIONAL AND SERVICE ACTIVITIES (SUM OF A-20, 8-14, C4 & D)

Effective July 20, 1976