Connecticut Board of Education Data Acquisition Plan 1989-1990
Unannotated Secondary Research
January, 1989 - January, 1990
43 pages
Cite this item
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Case Files, Sheff v. O'Neill Hardbacks. Connecticut Board of Education Data Acquisition Plan 1989-1990, 1989. 717bcd2e-a446-f011-8779-7c1e5267c7b6. LDF Archives, Thurgood Marshall Institute. https://ldfrecollection.org/archives/archives-search/archives-item/1a2170d6-bda7-41fa-972d-7b207b465ae3/connecticut-board-of-education-data-acquisition-plan-1989-1990. Accessed July 29, 2025.
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DATA
ACQUISITION
PLAN
1989 - 1990
STATE OF CONNECTICUT BOARD OF EDUCATION — 1989
State of Connecticut
William A. O'Neill, Governor
Board of Education
Abraham Glassman, Chairperson
Rita L. Hendel, Vice Chairperson
George T. Carofino
A. Walter Esdaile
Warren J. Foley
Beverly P. Greenberg
Lucas Isidro
John F. Mannix
Julia S. Rankin
Norma Foreman Glasgow (ex officio)
Commissioner of Higher Education
Gerald N. Tirozzi
Commissioner of Education
Frank A. Altieri
Deputy Commissioner
Finance and Operations
Scott Brohinsky
Deputy Commissioner
Program and Support Services
It is the policy of the Connecticut State Board of Education that no person shall be
excluded from participation in, denied the benefits of, or otherwise discriminated against
under any program, including employment, because of race, color, sex, national origin,
religion, age, mental or physical disability, mental retardation, or marital status.
DATA
ACQUISITION
PLAN
1989 - 1990
Foreword
Preface
Explanatory Notes
Part I: Numerical Index of Forms
Part II: Monthly Calendar of Forms
CONTENTS
vii
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FOREWORD
This is the 13th annual Data Acquisition Plan of the Connecticut State Department of Education. As with earlier editions, the Data Acquisition Plan 1989-1990 lists the forms that the State Department of Education will use in the coming school year to collect data on the condition and the progress of education in Connecticut.
It is impossible to administer education responsibly without good information. While this necessitates a strong data collection effort, I continue to be concerned about the paperwork burden on administrators and teachers. I renew my pledge to minimize this burden.
First, we review all department forms every year. We are continually trying to improve their design so that the forms can be more speedily and accurately completed by respondents and analyzed by department staff. We also try to eliminate any unnecessary or duplicate requests for data.
Second, we seek actively to promote the use of computers to ease data reporting requirements. I pledge that we will expand opportunities for submitting data electronically.
I offer my thanks to local school staff for their work in responding to our requests for data. Only with accurate and timely data can we give Connecticut's citizens meaningful information about our public schools and respond appropriately in our administration of education in
Connecticut.
Gerald N. Tir¥zzi
Commissioner of Education
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PREFACE
The Data Acquisition Plan 1989-1990 has two parts:
Oo. ‘Papt 1: Numerical Index of Forms
o Part II: Monthly Calendar of Forms
Part I presents a numerical listing of all forms required of local
school districts. It includes all State Department of Education forms
and all forms required by other agencies, even biennial/triennial forms
not due this school year.
Part II provides a September to August calendar, listing forms due
this school year according to their due dates.
The preparation of the Data Acquisition Plan is supported by the
work of the State Department of Education Forms Review Committee which
must annually approve all department forms. The committee meets monthly
to review new or continued forms.
In addition, the department recognizes the continuing assistance of
the CASA/CASBO Data Reports Committee, a joint committee of the
Connecticut Association of School Administrators and the Connecticut
Association of School Business Officials. Together with this group, the
Department of Education has prepared a brochure, Data Collection
Procedures. Relating to Public Elementary and Secondary Institutions of
Education in Connecticut, which outlines the procedures to be followed
in soliciting information from education agencies. Copies are available
on request.
The department will consider all suggestions to consolidate forms or
otherwise to make reporting procedures more efficient. Questions or
suggestions concerning forms or data acquisition matters should be
directed to Thomas F. Breen III, Data Collection and Analysis Unit,
566-5635.
Local school district personnel are encouraged to respond only to
surveys which have been approved by the Department of Education or by
the CASA/CASBO Data Reports Committee. Surveys without such approval
are entirely voluntary. Questions about approval may be addressed to
Dr. Breen.
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EXPLANATORY NOTES
The table headings in this report are defined as follows:
0
0
"Date Due State" gives the month and the day the form is due
at the state agency. The letters "M," ®Qv, "Ss," and *1"
following the form due date indicate that the form is due
monthly, quarterly, semiannually (January and July), or twice a
year (October and May), respectively. A due date "AsReq"
indicates that the form is used only as required. The letter
"E" indicates a due date estimated at this time; the actual due
date depends on federal release dates.
"Local Contact Person" is the person at the local level
responsible for submitting the form. The following
abbreviations are used: "Sup't" for Superintendent; "Sponsr" for
Sponsor; "Dirctr" for Director; "FdSMC" for Food Service
Management Company; "Prncpl" for Principal; "Teachr" for
Teachers; "Studnt" for Students; “Coordr" for Coordinator;
"Applcnt" for Applicant; "Emplyr" for Employer; "BdEduc" for
Board of Education; and "Admin" for Administrator. Some Teacher
Certification forms must be submitted jointly by both the
applicant and the employer; these are coded "App/Emp" or
"Emp/App".
"Form Type" groups each form in one of the following types:
Type "A" State Department of Education (SDE) forms which
are to be submitted by all superintendents this
year. Form titles for Type "A" forms are printed
in capital letters in this report.
Type "B" SDE forms which are submitted annually by a
minority of superintendents on specified due dates
or as required.
Type "C" SDE forms which are submitted by respondents other
than the superintendent.
Type "D" Forms which are distributed by agencies other than
the State Department of Education to collect
school district data.
Type "E" Forms which are submitted on a two-year,
three-year, or five-year cycle.
"Need" identifies the primary use of the form: "S" - State;
"F" - Federal; and "B" - both State and Federal.
“Form Number" is a letter and number combination given at the top of the form which identifies the source and number of the form. For example, most forms authorized for distribution by the Department of Education have the designation, ED, followed by a three-digit number, e.g., ED-001.
Other designations used within the department are
BAE -- Bureau of Adult Education,
DREA -- Division of Research, Evaluation and Assessment, and FRC -- Forms Review Committee.
Designations used by other agencies include
TRB -- Teachers' Retirement Board,
IMM -- Health Department (Immunization Survey), and
ED -- U.S. Department of Education
"Form Name: Justification" gives the title of the form and the federal or state statute which requires its use. State statutes are listed as "CGS" or "PA" and federal statutes as "PL" or "FR." To save space, words in the title are often abbreviated, e.g., STATMT for Statement; CHLDN for Children.
“State Contact Person" lists the person in the state agency who is responsible for administering the form.
"Telephone Number" gives the telephone number of the state contact person.
PART I
NUMERICAL INDEX OF FORMS
EA rn A ON I te 0 lA tt a Ltt a i” tn Tn i te it
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part |
Numerical Index of Forms Date Local
Due Contact Form Form
State Telephone
State Person Type Need Number Form Name: Justification
Contact Person Number
9-1. Sup't A S ED-001 END OF YEAR SCHOOL REPORT: CGS 10-227 Mark R. Stange 566-1 : 12-30 Sup't B S ED-001A Data Adjustment Form: CGS 10-227
Mark R. Stange 566-4861 9- 1 Dirctr Cc S ED-001R End of Year School Report--Reg Education Service Ctrs: CGS 10-227 Mark R. Stange 566-4861 8-18 Sup't A S ED-002 CERTIFICATE OF COMPLIANCE WITH LAW: CGS 10-260, -220 Mark Stapleton 566-3825 7-1 Sup't A S ED-003 TEACHER/ADMINISTRATOR NEGOTIATIONS: CGS 10-153a Leslie Williamson 566-2135 AsReq Sup't B S ED-004 Priority School District Program: CGS 10-266p-r Theodore S. Sergi 638-4000 7= 1° Sup't B S ED-O08A Mental Health Facilities Grant: CGS 10-76d(e)(5) Mark R. Stange 566-4861 5- 8 Sup't B S ED-008B Mental Health Facilities Grant: CGS 10-76d(e)(5) Mark R. Stange 566-4861 5- 8 Sup't B S ED-008C Mental Health Facilities Grant: CGS 10-76d(e)(5) Mark R. Stange 566-4861 AsReq Sup't A S ED-014 MINIMUM EXPENDITURE REQUIREMNT PRELIM COMPLIANCE CHECK: CGS 10-262e Martin Hollis 566-3431 11-15 Sup't A S ED-017 GRANT APPLICATION=-~NONPUBLIC HEALTH & WELFARE SERVICES: CGS 10-217a Mark R. Stange 566-4861 oo 10-157 Sup't A S ED-025 PUPIL DATA REPORT: CGS 10-261(a)
Mark R. Stange 566-4861 AsReq Sup't B S ED-025A Pupil Data Adjustment Form: CGS 10-261(a) Mark R. Stange 566-4861 AsReq Sup't B 5 ED-026 Pupil Data Conflict Form: CGS 10-261 Mark R. Stange 566-4861
10-15T Sup't A S ED-027 REGIONAL SCHOOLS PUPIL DATA REPORT (ED-025R): CGS 10-261, -53 Ma rk R. Stange 566-4861 AsReq Sup't B S ED-027A Pupil Data Adjustment Form: CGS 10-261(a) Mark R. Stange 566-4861
11-30. Sup’t A S ED-030 TEACHER SALARY GRANT APPLICATION: CGS 10-257a-g Mark R. Stange 566-4861
3 1 Sup't A S ED-031 TEACHER ALLOCATION REPORT: CGS 10-65(a), -67(b), =76f(h), -217a(b) Mark R. Stange 566-4861 6-30 Sup't B S ED-O40 Application for Proposed School Building Project: CGS 10-283 William D. Guzman 566-14) AsReq Sup't B S ED-O41 Notice of Applicant's Funding: CGS 10-283a William D. Guzman 566-7546 AsReq Sup't B S ED-O042 Request for Review of Final Plans: CGS 10-291 Richard Krissinger 566-2688 AsReq Sup't B S ED-043 Request for Est Int & Prin Bond Payment: CGS 10-287h William D. Guzman 566-7546 AsReq Sup't B S ED-044 Request for School Building Grant: CGS 10-287(d) William D. Guzman 566-7546 AsReq Sup't B S ED-0O45 Notice of Bond Issue: CGS 10-287 William D. Guzman 566-7546
AsReq Sup't B S ED-047 Notice of Short Term Note: CGS 10-289a William D. Guzman 566-7546
Designations--Form Type: A-Al| Superintendents (CAPS); B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual Need: S-State; F-Federal; B-Both
Date
Due
State
AsReq
8-15
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
10- 1
10- 1
10- 1
10- 1
9-15M
10- 1
9-15M
5-15
5-15
9-10M
AsReq
4-15
AsReq
AsReq
AsReq
Local
Contact Form
Type Person
Sup't
Sup't
Sup't
Sup't
Bldglinsp
Blidglinsp
Sup't
Sup't
Sup't
Sponsr
Sup't
Sponsr
Sponsr
Sponsr
Sponsr
Sponsr
Sponsr
Sponsr
FdSMC
Sponsr
Sponsr
Sponsr
Sponsr
B
Form
Need Number
S ED-048
ED-053
ED-072
ED-073
ED-075A
ED-0758B
ED-075C
ED-076
ED-080
ED-081
ED-083
ED-08Y4
ED-086
ED-087
ED-088
ED-090
ED-091
ED-092
ED-093
ED-094
ED-095
ED-096
ED-098
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part |
Numerical Index of Forms
Form Name: Justification
Notice of Start of Construction: CGS 10-284
Site Analysis Form: CGS 10-286d
Notice of Intent to Renew Temporary Notes: CGS 10-287f
Notice of Temporary Note Issue: CGS 10-287h
Area Asbestos Inspection Report: CGS 10-292b
School Facility Asbestos Inspection Report: CGS 10-292b
District Asbestos School Inspection Report: CGS 10-292b
ANNUAL ASBESTOS MANAGEMENT PLAN UPDATE: CGS 10-292b
POLICY STATMT--FREE & REDUCED MEALS & FREE MLK: 7-CFR 210, 215, 245
Nonpricing Program Policy Statement: 7-CFR 245.5(a)(x)
PAID MILK ONLY PROVISION: 7-CFR 215.13(a)(c)
Application--Child Care Food Program: 7-CFR 226.6(b)
Reimbursement Claim--for Day Care Centers: 7-CFR 226.11(b)
Application--Child Care Food Pgm--Day Care Homes: 7-CFR 226.6(b)
Reimbursement Claim--Day Care Homes: 7-CFR 226.12(b), 226.13(g)
Application--Summer Food Service Program: 7-CFR 225.8
Site Sheet--Summer Food Service Program: 7-CFR 225.8( |)
Reimbursement Claim--Summer Food Service Program: 7-CFR 225.11(c)
Application for Vendor Registration: 7-CFR 225.16(c)(1)
Compliance Agreement--Summer Food Service Program: 7-CFR 225.19(a)
Estimated Meal Counts--School Breakfast: CGS 10-266w
Certfication Letter--Summer Food Serv Prg--Sites Visited: 7-CFR 225
Civil Rights Survey--Preaward Comp Rev: 7-CFR 225.9(h), 226.6(e)
State
Contact
William
Richard
William
William
William
William
William
William
Janet H.
Janet H.
Janet H.
Maureen
Maureen
Maureen
Maureen
Maureen
Maureen
Maureen
Maureen
Maureen
Mary B.
Maureen
Maureen
Person
D. Guzman
Krissinger
D. Guzman
D. Guzman
D. Guzman
D. Guzman
D. Guzman
D. Guzman
Bantly
Bant ly
Bantly
Staggenborg
Staggenborg
Staggenborg
Staggenborg
Staggenborg
Staggenborg
Staggenborg
Staggenborg
Staggenborg
Ragno
Staggenborg
Staggenborg
Telephone
Number
566-7546
566-¢
566-7546
566-7546
566-7546
566-7546
566-7546
566-7546
566-3195
566-3195
566-3195
566-3195
566-3195
566-3195
566-3195
566-3195
566-3195
566-3195
566-3195
566-3)
566-3195
566-3195
566-3195
B
B
B
Cc
Cc
B
A
A
Cc
A
C
Cc
Cc
Cc
C
Cc
Cc
Cc
C
C
C
Cc
B
566-3195
566-3195
ED-099 PL 95-166 Janet H, Bant ly
ED-102
7- 1 Sup't Agreement for Child Nutrition Programs:
2-158 Janet H. Bantly M
B
N
MN
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Sponsr Cc Semi-Annual Revenue & Cost Expend Rpt: 7-CFR 210.15, 220.13(i)
A-All Superintendents (CAPS); B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annua |
Designations--Form Type:
F-Federal; B-Both Need: S-State;
wath mt Sint Sa eB NE ee CA tv Bt em rts A 6
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part |
Numerical Index of Forms Date Local
Due Contact Form Form
State Telephone
State Person Type Need Number Form Name: Justification
Contact Person Number 9-15M Sup't A F ED-103 REIMB CLAIM=--NAT SCH LUNCH, BRKFST & SPEC MILK: 7-CFR 210.11, 215.8 Janet H. Bantly 566- AsReq Sponsr A S ED-105 LUNCH COUNT RPRT==CHILD NUTRIT PROG: CGS 10-266w, 7-CFR 220.9(e) (3) Mary B. Ragno 566-3195 9-1 Sponsr B B ED-106 State Schl Breakfst Rpt, Costs & Income: CGS 10-266w, 7-CFR 220.9(d) Mary B. Ragno 566-3195 10- 1 Sup't B F ED-107 Sponsor Representation Letter--Child Nutrition Programs: CGS 7-396a Janet H. Bantly 566-3195 AsReq Sponsr C F ED-109 Application--Start-up Paymnts--Child Care Prg: 7-CFR 226.7(h),.12(b) Maureen Staggenborg 566-3195 AsReq Sup't A B ED-110 CASH FLOW PROJECTION STATEMENT: 34-CFR 74.61(e) Annette McCal | 566-5959 9« 5M Sup't A B ED-111 STATUS OF CASH REPORT--PREPAYMENT GRANT PROGRAMS: R=34,-74, -74c, -T4d Annette McCall | 566-5959 AsReq Sup't B S ED-114 Prepayment Grant Budget Request: PL 99-570 Donald P. Bernard 566-4989 AsReq Sup't A B ED-141 STATEMENT OF EXPENDITURE FED & STATE PREPAYT PROJS: R-34,-73,-74 Donald P. Bernard 566-4989 AsReq Sup't A F ED-142 STATEMENT OF EXPEND CARRYOVER=--FED PREPAYT PROJ: R-34,-73,-74 Donald P. Bernard 566-4989 AsReq Sup't A F ED-143 LIQUIDATION OF OBL IGATIONS~-~FED PREPAYMENT PROJECTS: R-34,-73,-74 Donald P. Bernard 566-4989 0 7-1 .Sup’'t A S ED-147 SCHOOL DISTRICT CALENDAR SURVEY: CGS 10-15,-16,-161 Thomas F., Breen || 566-5635 12-1 ‘Sup't E S ED-148 Graduating Class Report: CGS 10-221a
Stephen J. Ruffini 566-5446 AsReq Sup't E S ED-149 Curriculum Survey: CGS 10-16b
George Coleman 566-6645 6-15 Sup't E S ED-150 Teacher Evaluation Program Implementation Rpt: CGS 10-151b, -155ff Gloria Williams 566-7258 11-1. Sup't E S ED-151 Biennial Report--Educ Evaluation & Remedial Assistance: CGS 10-14m Peter Behuniak 566-4008 10-15 Sup't A S ED-152 RACIAL SURVEY: CGS 10-226a
Thomas F. Breen I1l 566-5635 10-13 Sup't A S ED-153 EERA STUDENT PARTICIPATION REPORT: CGS 10-14m Peter Behuniak 566-4008 6-15 .Sup't A S ED-155 ENUMERATION REPORT: CGS 10-249 to =-250 Richard J. Cloud 566-16) 9-15 Sup't A S ED-156 TEACHER SHORTAGE SURVEY: CGS 10a-163
Peter M. Prowda 566-7117 12-1 _Sup't A S ED-158P PUBLIC HIGH SCHOOL GRADUATE FOLLOW-UP: CGS 10-224, -188 Judith Thompson 566-7369 12- 1 Dirctr Cc S ED-158NPNonpublic High School Graduate Follow-up: CGS 10-224, -188 Judith Thompson 566-7369 10-15 Prncpl C S ED-159 Nonpublic School Report: CGS 10-188
Thomas F. Breen || 566-5635 5-15 Prncpl C S ED-159A Nonpublic School Report: CGS 10-188, -217a, =-281 Mark R. Stange 566-4861 9«~ 1 Sup't A F ED-160 ECIA CHAPTER 2 EVALUATION: PL 100-297
Charlene Gower "566-4377 Designations--Form Type: A-All Superintendents (CAPS); B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual Need: S-State; F-Federal; B-Both
Date
Due
State
5-15
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
7-15
AsReq
AsReq
AsReq
6-30
6- 1
Designations--Form Type:
S-State;
Local
Contact
Person
Sup't
Applcnt
Emplyr
App/Emp
App/Emp
Emp/App
Emplyr
Applcnt
App/Emp
Emplyr
Sup't
Applcnt
Applcnt
App/Emp
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
Dirctr
Sup't
Sup't
Form
Type
A
Cc
C
Cc
Cc
Cc
C
Cc
C
Cc
A
C
C
Cc
A
A
B
B
B
B
B
B
Cc
B
B
Need:
Form
Need Number
S
#
S
S
S
S
S
S
S
S
S
S
S
s
B
F
F
F
r
F
B
F
F
F
F
ED-169
ED-170
ED-171
ED-172
ED-173
ED-174
ED-175
ED-176A
ED-177
ED-178
ED-180
ED-184
ED-185
ED-186
ED-203
ED-203a
ED-203b
ED-203c
ED-203d
ED-204
ED-205
ED-206
ED-209
ED-210
ED-211
A-Al| Superintendents (CAPS); B-Some Superintendents; C-Others;
F-Federal;
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part -i
Numerical Index of Forms
Form Name: Justification
PROFESSIONAL DEVELOPMENT GRANT: CGS 10-155dd
Genrl Applctn: Teacher, Spec Serv Staff or Admin: CGS 10-1440, 145d
Stmnt of.,Professional Experience for Init Cert: CGS 10-1440, 145d
Request-Temp 90-day Certif-Altrnt Rte Candidates: CGS 10-1440, 145d
Request-Temporary Authorization for Minor Assignmnt: CGS 10-145b
Application-Special Substitute Teacher Authorization: CGS 10-145d
Application-Extension Substitute Authorization: CGS 10-145d
Request-Conversion of Standard or Permanent Cert: CGS 10-145b
Request-Durational Shortage Area Permit: CGS 10-145b
Bilingual Educator: Rqst Deferral of Certif Rqrmnts: CGS 10-145d
REPORT OF THREATS AND ASSUALTS IN SCHOOLS: CGS 10-233g
Request-Course Work Deficncy & CONNCEPT/CONNTENT Defrrl: CGS 10-145d
Application for Coaching Permit: CGS 10-149, -145d
Application-Temp/Emergency Coaching Permit: CGS 10-149, =-145d
LOCAL SCHOOL DIST APPLN FOR COMP ED GRANTS: CGS 10-14m-r, PL 100-297
LOCAL SCHOOL DIST APPLN FOR CAPITAL EXPENSES GRANT: PL 100-297
Chapter 1 Neglected & Delinquent Children Appin (State): PL 100-297
Chapter 1 Neglected & Delinquent Children Surv (Local): PL 100-297
Chapter 1 Neglected & Delinquent Children Surv (State): PL 100-297
Chapter 1 Evaluation Rprt--Neglected & Delinqunt Chidrn: PL 100-297
Compensatory Program Project Info Summary: CGS 10-140(b), PL 100-297
Application--Migrant Education Grants-Chapter 1 ECIA: PL 100-297
Migrant Program Evaluation Report: PL 100-297
PL 99-570
PL 100-297
Drug Free Schools and Communties Act of 1986:
Eisenhower Math & Science Education Act, Title II:
B-Both
State
Contact Person
Dick Vaillancourt
Pat Scully
Pat Scully
Pat Scully
Pat Scully
Pat Scully
Pat Scully
Pat Scully
Pat Scully
Pat Scully
Thomas F. Breen
Pat Scully
Pat Scully
Pat Scully
Diana Whitelaw
Diana Whitelaw
Diana Whitelaw
Diana Whitelaw
Diana Whitelaw
Carlos Martinez
Carlos Martinez
Carol Gilchrist
Carlos Martinez
Judy Carson
Judy Carson
Telephone
Number
566-57
a
566-1700
566-1700
566-1700
566-1700
566-1700
566-1700
566-1700
566-1700
566-5635
566-1700
566-1700
566-1700
638-4224
638-4224
638-4224
638-4224
638-4224
566-4
566-4377
638-4225
556-4377
566-2931
566-2931
D-Other Agency Forms; E-Not annual
A a eat a SN AGA i i ri mia oe ions er te Sn 2
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part |
Numerical Index of Forms Date Local
Due Contact Form Form
State Telephone
State Person Type Need Number Form Name: Justification
Contact Person Number, 6-15E Sup't A B ED-215 EDUCATION OF THE HAND ICAPPED=-Part B: PL 94-142 David Murphy 638-4 6-15E Sup't B B ED-216A Application for Grant Approval (Five or Fewer Children): PL 89-313 David Murphy 638-4240 6-15E Sup't B B ED-216B Application for Grant Approval (Six or more children): PL 89-313 David Murphy 638-4240 6-15E Sup't B B ED-216C Application for Grant Approval (State Oper/Supp Agencs): PL 89-313 David Murphy 638-4240 6-15E Sup't B F ED-217 Application: Preschool Handicapped Entitlement Grant: PL 99-457 Kay Halverson 566-5670 6-15 Sup't A F ED-222 GRANT APPLICATION: CHAPTER 2: PL 100-297 Joan Shoemaker 638-4205 AsReq Sup't B F ED-226 Trans Pgm for Refugee Children--Application: PL 96-212, 99-605 George DeGeorge 638-4253 11=_1 Sup't A S ED-228 ASSESSMENT OF DOMINANT LANG & ENGLISH LANG PROFICIENCY: CGS 10-17F David S. Cleaver 566-5635 7- 1... Sup't B S ED-229 Bilingual Education Grant Application: CGS 10-17g Angie Soler Galiano 638-4264 O9« 1. Sup't B S ED-230 LEA Bilingual Education Evaluation: CGS 10-17f,g Cynthia Prince 566-5671 AsReq Sup't B F ED-234 Refugee Student Survey Report Form: PL 96-212, 99-605 George DeGeorge 638-4253 od] 11-30 Sup't B F ED-235 Trans Pgm for Refugee Children--Annual Progrss Rpt: PL 96-212,99-605 George DeGeorge 638-4253 AsReq Sup't B F ED-236 Immigrant Student Survey Report Form: PL 98-511 George DeGeorge 638-4253 AsReq Sup't B F ED-237 Emergency Immigrant Education Pgm--Grant Application: PL 98-511 George DeGeorge 638-4253 AsReq Sup't B F ED-238 Emergency Immigrant Education Pgm=--Annual Progress Report: PL 98-511 George DeGeorge 638-4253 8-1 Sup't A B ED-241 ADULT EDUCATION SUMMARY REPORT: CGS 10-67,-73b, PL 100-297 Roberta Pawloski 638-4160 2-15 Sup't A B ED-244 GRANT APPLICATION--ADULT EDUCATION: CGS 10-67,-73b, PL 100-297 Roberta Pawloski 638-4160 2~15 Sup't A B ED-245 GRANT APPLICATION REVISION--ADULT EDUCATION: CGS 10-69, PL 100-297 Roberta Pawloski 638-4160 6-15 Sup't B B ED-291 Annual Driver Education Report: CGS 10-24 Gregory C. Kane 638-40 6-15 Sup't B S ED-292 Approval of School Driver Education Program: CGS 10-24 Gregory C. Kane 638-4067 11-30 Sup't A S ED-300 School Building Tax Questionnaire: PL 99-514 William D. Guzman 566-7546 AsReq Admins C S ED-301 Statement of Age (Working Papers): CGS 31-23 Natalie Rapoport 638-4162 6- 2 Dirctr C S ED-310 Application: Approval of Occupational Schools: CGS 10-7a-1| Priscilla Boivin 638-4159 AsReq Dirctr C F ED-315 Appin for Aprvl to Train Vets/Elig Dpndts: Deg Grntg Schl: PL 89-358 Edward Sampt 638-4164 AsReq Dirctr Cc F ED-316 Appin for Aprvl to Train Vets/Elig Dpndts: Non-Deg Grantg: PL 89-358 Edward Sampt 638-4164 Designations--Form Type: A-All Superintendents (CAPS); B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual i Need: S-State; F-Federal; B-Both
2
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part |
Numerical Index of Forms
Date Local
Due Contact Form Form
State Person Type Need Number Form Name: Justification
AsReq Sup't B S ED-322 Grant Application for Regional Special Educatn Facility: CGS 10-76e
12- 1 Sup't A B ED-331 SPECIAL EDUCATION CENSUS: PL 89-313, 94-142, CGS 10-76a-s
12- 1 Sup't A B ED-332 FUNDING ELIGIBILITY: PL 89-313, CGS 10-4, =-76, -253
5-15 Sup't B F ED-340 Certification Form--Handicapped Studnts in Voc Educ: PL 98-524
5-26 * A B ED-400A VOC EDUC SECONDARY ENROLLMENT & COMPLETION RPT: CGS 10-4, PL 98-524
5-206 * A B ED-400B VOC EDUC POST-SECONDRY ENRLLMNT & COMPLETN RPT: CGS 10-4, PL 98-524
5-19 * A B ED-400C DISADV & LMTED ENGL PROF STUDENTS IN VOCATIONAL PROGRAMS: PL 98-524
10- 1 Sup't A S ED-401 VOCATIONAL EDUCATION STUDENT ADMISSION REPORT: CGS 10-95, -97
3-15 +» A B ED-404 COMPLETER FOLLOW-UP REPORT FOR VOC ED PGM: CGS 10-95,-97, PL 95-524
9-30 Sup't B F ED-440 Grant Application, Carl Perkins Voc Ed Act: PL 98-524
6- 1 Sup't B F ED-452 Debt Service Claim Form: CGS 10-261a
9- 1 Sup't B S ED-470 Vocational Equipment Grant Application: CGS 10-265a-d
12- 3 Sup't+ B S ED-471 OIC Equipment Grant Application: CGS 10-265c, PA 87-405
AsReq BdEduc Cc S ED-501 Preliminary Application for Aprvl, Regnl Vo-Ag Facility: CGS 10-284
10-10 Teachr Cc S ED-503 Vo-Ag Center Fall Report: CGS 10-66
7- 1 Sup't E S ED-511 Local Education Goals Report: CGS 10-220 (b)
6- 1 Dirctr Cc F ED-512 Application: Early Childhood Network Grant: PL 99-457
6-15 Sup't E S ED-515 Teacher Evaluation Plan Report Form: CGS 10-151b, -155ee, =-155ff
AsReq Sup't B F ED-516 Trans Prog for Refugee Children: Carry-over Grant Appl: PL 99-605
AsReq Sup't B F ED-517 Emergncy Immgrnt Educ: Pgm: Carry-over Grant Appl: PL 98-511
7- 6 Sup't A B ED-518 AIDS EDUCATION SURVEY: 42 U.S.C. 241 (a)
AsReq Dirctr Cc S BAE-001 Out-of-State Prvt Occptnl Schis: Schl Info for Permit: CGS 10-7i
AsReq Dirctr C S BAE-002 Out-of-State Prvt Occptnl Schis: Representative Info: CGS 10-7i
AsReq Dirctr C S BAE-003 Out-of-State Prvt Occptnl Schis: Receipts Deposit: CGS 10-7i
10-31Q Dirctr Cc S BAE-004 Qurtrly Pmnt Form--Prvt Occup Schl Stud Protectn Fund: CGS 10-14i
*Sup"t., V.T. Dir., Comm. Col. Pres., Tech. Col. Pres., and Other Agencies.
Designations--Form Type: A-All Superintendents (CAPS); B-Some Superintendents; C-Others;
Need: S-State; F-Federal; B-Both
State
Contact
Alan J.
Person
White
George T. White
George T. White
Judith Thompson
William
William
William
William
William
Valerie
Mark R.
Choquette
Choquette
Choquette
Choquette
Choquette
Pichanick
Stange
Joseph Petrone
Joseph Petrone
Roger W. Lawrence
Roger W. Lawrence
Elizabeth Schmitt
Kay Halverson
Gloria Williams
George DeGeorge
George DeGeorge
Elaine Brainerd
Priscilla Boivin
Priscilla Boivin
Priscilla Boivin
Priscilla Boivin
D-Other Agency Forms;
Telephone
Number
566-3
566-3461
566-7369
566-3444
566-3441
566-34Lk4
566-34LY
566-3444
638-4060
566-4861
638-4058
638-4058
638-4054
638-4054
566-1961
566-5670
566-7258
638-4253
638-4
638-4227
638-4159
638-4159
638-4159
638-4159
E-Not annual
pd
o
Date Local
Due Contact
State Person
6- 2 Dirctr
6- 1 Sup't
10-15 *
AsReq Sup't
AsReq Sup't
AsReq Dirctr
AsReq Sup't
AsReq Sup't
AsReq Sup't
AsReq Sup't
9-15 Sup't
9-15 Sup't
9-15 Sup't
AsReq BdEduc
6-30 BdEduc
9-30M BdEduc
9-30M BdEduc
9-30M BdEduc
6-30M BdEduc
9-30M BdEduc
9-30M BdEduc
9-30M BdEduc
AsReq BdEduc
9-10M BdEduc
9-10M BdEduc
¥Sup't., V.T.
Designations--Form Type:
S-State;
Form
Type
C
B
Cc
B
B
C
B
B
B
B
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
Dir.,
Need:
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part |
Numerical Index of Forms
Form
Need
S FRC-003 Letter of Financial
Number Form Name: Justification
Commitment and Responsibility: CGS 10-7c(a)(2)
FRC-004 Application: Birth to Three Continuation Grant: PL 94-142
FRC-009 Fall Vocational Program Report
DREA100SPupi | Counts for Funding under PL 94-142
DREA100UPupil Counts for Funding under PL 89-313
DREA502 Students Identified or Receiving Educ, by Site Location
DREA680 Excess Cost Grant Placements
DREA690 Students Placed Out by a State Agency Who Require Spec Education
DREA691 State Agency Placements, Residential, Spec Educ in School District
DREA692 Students Req Educ Only, St Agncy in Prvt Resid Facility
TRBO3
TRBO3A
TRBO3L
TRBO8
TRBOSA
TRBO8C
TRBOSE
TRBO8S
TRB10
TRB10A
TRB1OL
TRB1Y4
TRB19A
S TRB19B
Comm.
B
F
F
S
S
S
S
S
S
S
S
S TRBOY4
S
S
s
S
s
S
s
S
S
S
Col.
A-All Superintendents (CAPS);
ANNUAL SCHOOL STAFF REPORT (Preprinted): CGS 10-183n
ANNUAL SCHOOL STAFF REPORT ATTACHMENT: CGS 10-183n
LEAVE OF ABSENCE REPORT: CGS 10-183n
Teacher's Application for Retirement: CGS 10-183n
Annual Report of Retirement Deductions: CGS 10-183n
Town Report of Monthly Deposit & Member Terminations: CGS 10-183n
Town Report of Monthly Leave Payments: CGS 10-183n
Town Report of Monthly Installment Payments: CGS 10-183n
Town Report of Annual Substitute Service: CGS 10-183v
Report of Changes During the School Year: CGS 10-183n
Report of Substitute Service by Retired Teachers: CGS 10-183n
Report of Teacher's Absences & Leaves: CGS 10-183n
Disability Application From Town for Member's Retirt: CGS 10-183n
Transfer Form: CGS 10-183n
Name/Address Changes: CGS 10-183n
Tech, Col. and Other Agencies. Pres. Pres. , »
F-Federal; B-Both
EA a TN Sen 0 ch 0 BS tt ir he Bl
State
Contact Person
Priscilla Boivin
Kay Halverson
William Choquette
George T. White
George T. White
George T. White
George T. White
George T. White
George T. White
George T. White
Stella Kulagowski
Stella Kulagowski
Stella Kulagowski
Gail Barton
Betty Bazin
Maria Todd
Maria Todd
Dorothy Holmes
Dorothy Holmes
Stella Kulagowski
Gail Barton
Stella Kulagowski
Gail Barton
Stella Kulagowski
Stella Kulagowski
Telephone
Number
s35-1ff)
566-5670
566-3444
566-3461
566-3461
566-3461
566-3461
566-3461
566-3461
566-3461
566-2875
566-2875
566-2875
566-5285
566-2875
566-3889
566-3889
566-5520
566-5
566-2875
566-5285
566-2875
566-5285
566-2875
566-2875
B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part |
Numerical Index of Forms
Date Local
Due Contact Form Form
State Telephone State Person Type Need Number Form Name: Justification Contact Person Number
9-15 BdEduc D S TRB20 Requisition Form: CGS 10-183n Suzanne Bock 566-38
9-15 BdEduc TRB21 Town Officers: CGS 10-183n Stella Kulagowski 566-2
AsReq BdEduc TRB25 Physician's Confidential Report: CGS 10-183n Gail Barton 566-5285
AsReq BdEduc TRB25C Physician's Report of Illness: CGS 10-183n Maria Todd 566-3889
AsReq BdEduc TRB27 Application for Withdrawal of Member's Deposits: CGS 10-183n Suzanne Bock 566-3889
AsReq BdEduc TRB27V Application for Withdrawal of Voluntary Deposits: CGS 10-183n David Seltzer 566-2875
AsReq BdEduc TRB31A Reinstatement Application: CGS 10-183n Stella Kulagowski 566-2875
9-30M BdEduc TRB33C Statement of Payment Plan--Period Certain: CGS 10-183 Gail Barton 566-5285
9-30M BdEduc TRB33D Statement of Payment Plan--Co-Participant: CGS 10-183 Gail Barton 566-5285
TRB33N Statement of Payment Plan--Normal: CGS 10-183 Gail Barton 566-5285
AsReq BdEduc TRB3Y Beneficiary Designation: CGS 10-183n Jeannette Celani 566-5285
AsReq BdEduc TRB34T Trustee Designation: CGS 10-183n Jeannette Celani 566-5285
AsReq BdEduc TRBS53 Authorization of Formal Leave of Absence: CGS 10-183n Stella Kulagowski 566-2875
AsReq BdEduc TRB81 Authorization of Voluntary Deductions: CGS 10-183 Suzanne Bock 566-3889
11- 8 Coordr I MMYy School Immunization Survey Summary: CGS 10-20U4a Dennis J. Dix 566-4141
1-30 Sup't ED-U019 Application--School Assistance in Fedrlly Affected Areas: PL 81-874 Mark R. Stange 566-3430
S
T
I
S
R
C
L
Y
y
e
n
AsReq Sup't OE-U423 Application for Disaster Assistance: PL 81-874 William D. Guzman 566-7546
12-15 Sup't ED101 Civil Rights Survey--Schl System Summary: PL 88-352, 92-318, 93-112 Thomas F. Breen tll 566-5635
D
D
D
D
D
D
D
D
9-30M BdEduc D
D
D
D
D
D
D
D
D
D mn
=
ED102 Civil Rights Survey--Individual Schl Rpt: PL 88-352, 92-318, 93-112 Thomas F. Breen Ill 566-5635
12-15 Sup't
Designations--Form Type: A-All Superintendents (CAPS); B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual
Need: S-State; F-Federal; B-Both
12
R
E
—
PART II
MONTHLY CALENDAR OF FORMS
13
—
SS
Date
Due
State
9- 1
9- 1
9-3
9-1
9- 5M
9-10M
9-10M
9-10M
9-15M
9-15M
9-15M
9-15
9-15
9-15
9-15
9=15
9-15
9-30
9-30M
9-30M
9-30M
Local
Contact
Person
Sup't
Dirctr
Sponsr
Sup't
Dirctr
Sup't
Sup't
Sup't
Sponsr
BdEduc
BdEduc
Sponsr
Sponsr
Sup't
Sup't
Sup't
Sup't
Sup't
BdEduc
BdEduc
Sup't
BdEduc
BdEduc
BdEduc
Form
Type
A
C
B
A
C
B
B
A
Cc
D
D
Cc
C
A
A
D
D
D
D
D
B
D
D
D
Designations--Form Type:
S-State; Need:
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part II
Monthly Calendar of Forms
SEPTEMBER
Form
Need Number
S ED-001
ED-001R
ED-106
ED-160
ED-209
ED-230
ED-470
ED-111
ED-092
TRB19A
TRB19B
ED-088
ED-103
ED-156
TRBO3
TRBO3A
TRBO3L
TRB20
TRB21
ED-440
TRBOSA
TRBO8C
S TRBOSE
s
B
F
F
S
S
B
F
S
S
F ED-086
;
r
S
S
S
S
S
S
F
S
S
A-All Superintendents (CAPS);
Form Name: Justification
END OF YEAR SCHOOL REPORT: CGS 10-227
End of Year School Report--Reg Education Service Ctrs: CGS 10-227
State Schl Breakfst Rpt, Costs & Income: CGS 10-266w, 7-CFR 220.9(d)
ECIA CHAPTER 2 EVALUATION: PL 100-297
Migrant Program Evaluation Report: PL 100-297
LEA Bilingual Education Evaluation: CGS 10-17f,g
Vocational Equipment Grant Application: CGS 10-265a-d
STATUS OF CASH REPORT--PREPAYMENT GRANT PROGRAMS: R-34,~-74,-Tl4c,-T74d
Reimbursement Claim--Summer Food Service Program: 7-CFR 225.11(c)
Transfer Form: CGS 10-183n
Name/Address Changes: CGS 10-183n
Reimbursement Claim=--for Day Care Centers: 7-CFR 226.11(b)
Reimbursement Claim--Day Care Homes: 7-CFR 226.12(b), 226.13(g)
REIMB CLAIM--NAT SCH LUNCH, BRKFST & SPEC MILK: 7-CFR 210.11, 215.8
TEACHER SHORTAGE SURVEY: CGS 10a-163
ANNUAL SCHOOL STAFF REPORT (Preprinted): CGS 10-183n
ANNUAL SCHOOL STAFF REPORT ATTACHMENT: CGS 10-183n
LEAVE OF ABSENCE REPORT: CGS 10-183n
Requisition Form: CGS 10-183n
Town Officers: CGS 10-183n
Grant Application, Carl Perkins Voc Ed Act: PL 98-524
Town Report of Monthly Deposit & Member Terminations: CGS 10-183n
Town Report of Monthly Leave Payments: CGS 10-183n
Town Report of Monthly Instal Iment Payments: CGS 10-183n
F-Federal; B-Both
State
Contact Person
Mark R. Stange
Mark R. Stange
Mary B. Ragno
Charlene Gower
Carlos Martinez
Cynthia Prince
Joseph Petrone
Annette McCall
Maureen Staggenborg
Stella Kulagowski
Stella Kulagowski
Maureen Staggenborg
Maureen Staggenborg
Janet H. Bantly
Peter M. Prowda
Stella Kulagowski
Stella Kulagowski
Stella Kulagowski
Suzanne Bock
Stella Kulagowski
Valerie Pichanick
Maria Todd
Maria Todd
Dorothy Holmes
Te l ephgae
numb df
566-4861
566-4861
566-3195
566-4377
556-4377
566-5671
638-4058
566-5959
566-3195
566-2875
566-2875
566-3195
566-3195
566-3195
566-7117
566-2875
566-2875
566-2
566-3889
566-2875
638-4060
566-3889
566-3889
566-5520
B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual
Date Local
Due Contact Form
State Person Type
9-30M BdEduc D
9-30M BdEduc
9-30M BdEduc
9-30M BdEduc
9-30M BdEduc
9-30M BdEduc
om
R
r
S
T
©
Ll
ve
EE
>
Ti
9-30M BdEduc
p—
ol
Designations--Form Type: A-Al|l Superintendents
S-State; Need:
Form
Need Number
S
Lv
BR
C
7
SR
E
E
E
C
E
TRBO8S
TRB10
TRB10A
TRB10OL
TRB33C
TRB33D
TRB33N
F-Federal;
Form
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part 11
Monthly Calendar of Forms
SEPTEMBER (Cont.)
Name: Justification
Town Report of Annual Substitute Service: CGS 10-183v
Report of
Report of
Report of
Statement
Statement
Statement
Changes During the School Year: CGS 10-183n
Substitute Service by Retired Teachers: CGS 10-183n
Teacher's Absences & Leaves: CGS 10-183n
of Payment Plan--Period Certain: CGS 10-183
of Payment Plan--Co~Participant: CGS 10-183
of Payment Plan--Normal: CGS 10-183
B-Both
State
Contact Person
Dorothy Holmes
Stella Kulagowski
Gail Barton
Stella Kulagowski
Gail Barton
Gail Barton
Gail Barton
Telephone
Number
566-13
566-2875
566-5285
566-2875
566-5285
566-5285
566-5285
(CAPS); B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual
n 3 - " - » or Lo Sw A HES B8 ne
5 a hs AI I on Shr ITC Gl Te pM ae A I 5 Ee Me er Ga as DN LE] Be 5 Ty 4 XB ae he
Connecticut State Department of Education Data Acquisition Plan 1989-90
Part II
Monthly Calendar of Forms
OCTOBER Date Local
Due Contact Form Form ok i
State ec dlil)e
State Person Type Need Number Form Name: Justification
Contact Person Numb T0- 1 Sup't A F ED-080 POLICY STATMT--FREE & REDUCED MEALS & FREE MLK: 7-CFR 210, 215, 245 Janet H. Bantly 566-3195 10- 1 Sponsr Cc ED-081 Nonpricing Program Policy Statement: 7-CFR 245.5(a) (x) Janet H. Bantly 566-3195 10- 1 Sup't A F ED-083 PAID MILK ONLY PROVISION: 7-CFR 215.13(a)(c)
Janet H. Bantly 566-3195 10- 1 Sponsr Cc F ED-084 Application--Child Care Food Program: 7-CFR 226.6(b) Maureen Staggenborg 566-3195 10- 1 Sponsr Cc F ED-087 Application--Child Care Food Pgm--Day Care Homes: 7-CFR 226.6(b) Maureen Staggenborg 566-3195 10~ 1 Sup't B F ED-107 Sponsor Representation Letter--Child Nutrition Programs: CGS 7-396a Janet H. Bantly 566-3195 10- 1 Sup't A S ED-401 VOCATIONAL EDUCATION STUDENT ADMISSION REPORT: CGS 10-95, =-97 William Choquette 566-3444 10- 5M Sup't A B ED-111 STATUS OF CASH REPORT--PREPAYMENT GRANT PROGRAMS; R=-34,-74, -74c, - 74d Annette McCall | 566-5959 10-10 Teachr Cc S ED-503 Vo-Ag Center Fal | Report: CGS 10-66
Roger W. Lawrence 638-4054 10-10M BdEduc D S TRB19A Transfer Form: CGS 10-183n
Stella Kulagowski 566-2875 ~ 10-10M BdEduc D S TRB19B Name/Address Changes: CGS 10-183n
Stella Kulagowski 566-2875 10-13 Sup't A S £ED-153 EERA STUDENT PARTICIPATION REPORT: CGS 10-14m
Peter Behuniak 566-4008 10-15T Sup't A S ED-025 PUPIL DATA REPORT: CGS 10-261(a)
Mark R. Stange 566-4861 10-15T Sup't A S ED-027 REGIONAL SCHOOLS PUPIL DATA REPORT (ED-025R): CGS 10-261, ~-53 Mark R. Stange 566-4861 10-15M Sponsr Cc F ED-086 Reimbursement Claim--for Day Care Centers: 7-CFR 226.11(b) Maureen Staggenborg 566-3195 10-15M Sponsr Cc F ED-088 Reimbursement Claim--Day Care Homes: 7-CFR 226.12(b), 226.13(g) Maureen Staggenborg 566-3195 10-15M Sup't A F ED-103 REIMB CLAIM--NAT SCH LUNCH, BRKFST & SPEC MILK: 7-CFR 210.11, 215.8 Janet H. Bantly 566-31 10-15 Sup't A S ED-152 RACIAL SURVEY: CGS 10-226a
Thomas F. Breen ||| oe 10-15 Prncpl Cc S ED-159 Nonpublic School Report: CGS 10-188
Thomas F. Breen 11] 566-5635 10-15 # C B FRC-009 Fall Vocational Program Report
William Choquette 566-344Y 10-31Q Dirctr C S BAE-004 Qurtriy Pmnt Form=--Prvt Occup Sch! Stud Protectn Fund: CGS 10-14 Priscilla Boivin 638-4159 10-31M BdEduc D S TRBOBA Town Report of Monthly Deposit & Member Terminations: CGS 10-183n Maria Todd 566-3889 10-31M BdEduc D S TRBO8C Town Report of Monthly Leave Payments: CGS 10-183n Maria Todd 566-3889 10-31M BdEduc D S TRBOBE Town Report of Monthly Instal iment Payments: CGS 10-183n Dorothy Holmes 566-5520 *Sup't., V.T. Dir., Comm. Col. Pres., Tech. Col. Pres., and Other Agencies, Designations--Form Type: A-All Superintendents (CAPS); B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual
Need: S-State; F-Federal; B-Both
p—
~N
Date Local
Due Contact
State Person
10-31M BdEduc
10-31M BdEduc
10-31M BdEduc
10-31M BdEduc
10-31M BdEduc
10-31M BdEduc
10-31M BdEduc
Form
Type
D
D
D
D
D
D
D
Designations--Form Type:
Need:
Form
Need Number
S TRBO8S
TRB10
TRB10A
TRB10OL
TRB33C
TRB33D
“w
o
u
o
nu
nu
nu
un
TRB33N
A-All Superintendents (CAPS);
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part 11
Monthly Calendar of Forms
OCTOBER (Cont.)
Form Name: Justification
Town Report of Annual Substitute Service: CGS 10-183v
Report of Changes During the School Year: CGS 10-183n
Report of Substitute Service by Retired Teachers: CGS 10-183n
Report of Teacher's Absences & Leaves: CGS 10-183n
Statement of Payment Plan--Period Certain: CGS 10-183
Statement of Payment Plan--Co-Participant: CGS 10-183
Statement of Payment Plan--Normal: CGS 10-183
S-State; F-Federal; B-Both
State
Contact Person
Dorothy Holmes
Stella Kulagowski
Gail Barton
Stella Kulagowski
Gail Barton
Gail Barton
Gail Barton
Telephor
Numbe §
566-5520
566-2875
566-5285
566-2875
566-5285
566-5285
566-5285
B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual
| <5
S
E
R
S
SA
pd
00]
Date
Due
Local
State Person
11-1
11-1
11- 5M
11- 8
11-10M
11-10M
11-15
11-15M
11-15M
11-15M
11-30
11-30
11-30
11-30M
11-30M
11-30M
11-30M
11-30M
11-30M
11-30M
11-30M
11-30M
11-30M
Sup't
Sup't
Sup't
Coordr
BdEduc
BdEduc
Sup't
Sponsr
Sponsr
Sup't
Sup't
Sup't
Sup't
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
Contact Form
Type
E
/
A
A
D
D
D
A
Cc
Cc
A
A
B
A
D
D
D
D
D
D
D
D
D
D
Need:
Form
Need Number
S
S
B
S
S
S
S
aq
F
r
S
F
S
5
S
S
S
S
S
s
S
S
S
S-State;
ED-151
ED-228
ED-111
| MMYy
TRB19A
TRB19B
ED-017
ED-086
ED-088
ED-103
ED-030
ED-235
ED-300
TRBOSA
TRBO8C
TRBOSE
TRBO8S
TRB10
TRB10A
TRB10OL
TRB33C
TRB33D
TRB33N
Designations--Form Type: A-All Superintendents
F-Federal; B-Both
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part 11
Monthly Calendar of Forms
NOVEMBER
Form Name: Justification
Biennial Report--Educ Evaluation & Remedial Assistance: CGS 10-14m
ASSESSMENT OF DOMINANT LANG & ENGLISH LANG PROFICIENCY: CGS 10-17f
STATUS OF CASH REPORT--PREPAYMENT GRANT PROGRAMS: R-34,-74,-TY4c, -Tu4d
School Immunization Survey Summary: CGS 10-20U4a
Transfer Form: CGS 10-183n
Name/Address Changes: CGS 10-183n
GRANT APPLICATION-~NONPUBLIC HEALTH & WELFARE SERVICES: CGS 10-217a
Reimbursement Claim=--for Day Care Centers: 7-CFR 226.11(b)
Reimbursement Claim--Day Care Homes: 7-CFR 226.12(b), 226.13(q)
REIMB CLAIM--NAT SCH LUNCH, BRKFST & SPEC MILK: 7-CFR 210.11, 215.8
TEACHER SALARY GRANT APPLICATION: CGS 10-257a-g
Trans Pgm for Refugee Children--Annual Progrss Rpt: PL 96-212,99-605
School Building Tax Questionnaire: PL 99-514
Town Report of Monthly Deposit & Member Terminations: CGS 10-183n
Town Report of Monthly Leave Payments: CGS 10-183n
Town Report of Monthly Installment Payments: CGS 10-183n
Town Report of Annual Substitute Service: CGS 10-183v
Report of Changes During the School Year: CGS 10-183n
Report of Substitute Service by Retired Teachers: CGS 10-183n
Report of Teacher's Absences & Leaves: CGS 10-183n
Statement of Payment Plan--Period Certain: CGS 10-183
Statement of Payment Plan--Co-Participant: CGS 10-183
Statement of Payment Plan--Normal: CGS 10-183
State
Contact Person
Peter Behuniak
David S. Cleaver
Annette McCall |
Dennis J. Dix
Stella Kulagowski
Stella Kulagowski
Mark R. Stange
Maureen Staggenborg
Maureen Staggenborg
Janet H. Bantly
Mark R. Stange
George DeGeorge
William D. Guzman
Maria Todd
Maria Todd
Dorothy Holmes
Dorothy Holmes
Stella Kulagowski
Gail Barton
Stella KulagowskKi
Gail Barton
Gail Barton
Gail Barton
Telephone
Number
566-40 \
566-5635
566-5959
566-4141
566-2875
566-2875
566-4861
566-3195
566-3195
566-3195
566-4861
638-4253
566-7546
566-3889
566-3889
566-5520
566-5520
566-2875
266-5207 2
566-2875
566-5285
566-5285
566-5285
(CAPS); B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual
C
E
T
A
S
E
Be
S
e
bE
TE
R
A
R
T
E
pt
O
Date
Due
State
12
12~-
12-
12~
12-
12-
1
1
1
Local
Contact
Person
Sup't
Dirctr
Sup't
Sup't
Sup't
Sup't+
Sup't
BdEduc
BdEduc
Sponsr
Sponsr
Sup't
Sup't
Sup't
Sup't
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
Form
Type
E
C
A
A
A
B
A
D
D
C
C
A
B
B
B
D
D
D
D
D
D
D
D
D
D
Need:
Form
Need Number
S ED-148
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part 11
Monthly Calendar of Forms
DECEMBER
Form Name: Justification
Graduating Class Report: CGS 10-221a
ED-158NPNonpubl ic High School Graduate Follow-up: CGS 10-224, -188
ED-158P PUBLIC HIGH SCHOOL GRADUATE FOLLOW-UP: CGS 10-224, -188
ED-331
ED-332
ED-471
ED-111
TRB19A
TRB19B
ED-086
ED-088
ED-103
ED-001A
ED-203d
TRBOSA
TRBO8C
TRBOSE
TRBO8S
TRB10
TRB10A
TRB1OL
TRB33C
TRB33D
TRB33N
Designations--Form Type: A-Al| Superintendents
F-Federal; S-State;
S
S
B
B
S
B
S
S
F
¢
F
S
F ED-203c
:
S
S
S
S
R
S
S
s
S
S
SPECIAL EDUCATION CENSUS: PL 89-313, 94-142, CGS 10-76a-s
FUNDING ELIGIBILITY: PL 89-313, CGS 10-4, -76, -253
OIC Equipment Grant Application: CGS 10-265c, PA 87-105
STATUS OF CASH. REPORT-=-PREPAYMENT GRANT PROGRAMS: R=-34,-74,-T7uc,-T4d
Transfer Form: CGS 10-183n
Name/Address Changes: CGS 10-183n
Reimbursement Claim--for Day Care Centers: 7-CFR 226.11(b)
Reimbursement Claim--Day Care Homes: 7-CFR 226.12(b), 226.13(qg)
REIMB CLAIM--NAT SCH LUNCH, BRKFST & SPEC MILK: 7-CFR 210.11, 215.8
Data Adjustment Form: CGS 10-227
Chapter 1 Neglected & Delinquent Children Surv (Local): PL 100-297
Chapter 1 Neglected & Delinquent Children Surv (State): PL 100-297
Town Report of Monthly Deposit & Member Terminations: CGS 10-183n
Town Report of Monthly Leave Payments: CGS 10-183n
Town Report of Monthly Install iment Payments: CGS 10-183n
CGS 10-183v Town Report of Annual Substitute Service:
Report of Changes During the School Year: CGS 10-183n
Report of Substitute Service by Retired Teachers: CGS 10-183n
Report of Teacher's Absences & Leaves: CGS 10-183n
Statement of Payment Plan--Period Certain: CGS 10-183
Statement of Payment Plan--Co-Participant: CGS 10-183
Statement of Payment Plan--Normal: CGS 10-183
B-Both
—
‘George
State
Contact Person
Stephen J.
Judith Thompson
Judith Thompson
T. White
T. White
George
Joseph Petrone
Annette McCal |
Stella Kulagowski
Stella Kulagowski
Maureen Staggenborg
Maureen Staggenborg
Janet H. Bantly
Mark R. Stange
Diana Whitelaw
Diana Whitelaw
Maria Todd
Maria Todd
Dorothy Holmes
Dorothy Holmes
Stella Kulagowski
Gail Barton
Stella Kulagowski
Gail Barton
Gail Barton
Gail Barton
(CAPS); B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual
Ruffini
Telephone
Number
566-54
566-7369
566-7369
566-3461
566-3461
638-4058
566-5959
566-2875 [4
566-2875 i
566-3195
566-3195
566-3195
566-4861 fH
638-4224
638-4224
566-3889 |
566-3889 |B
566-5520
266-222 ay 4
566-2875 [EH
566-5285 2
566-2875 :
566-5285 #
S
E
T
566-5285 2
i
566-5285 A
nN
o
Date
Due
State
1=- 5M
1-10M
1-10M
1-15M
1-15M
1-158
1-15M
1-30
1-31Q
1-31M
1-31M
1-31M
1-31M
1-31M
1-31M
1-31M
1-31M
1-31M
1-31M
Local
Contact
Person
Sup't
BdEduc
BdEduc
Sponsr
Sponsr
Sponsr
Sup't
Sup't
Dirctr
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
Designations--Form Type: A-All
S-State;
Form
Need Number
Form
Type
A B ED-111
D S TRB19A
D S TRB19B
Cc F ED-086
Cc F ED-088
Cc F ED=-102
A F ED-103
D F ED-4019
Cc S BAE-004
D S TRBOSA
D S TRBO8C
D S TRBOSE
D S TRBO8S
D S TRB10
D S TRB10A
D S TRB10OL
D S TRB33C
D S TRB33D
D S TRB33N
Need:
Form
STATUS OF
Connecticut State Department of Education Data Acquisition Plan 1989-90
Part 11
Monthly Calendar of Forms
JANUARY
Name: Justification
CASH REPORT--PREPAYMENT GRANT PROGRAMS: R=-34,-74,-74c, - 74d
Transfer Form: CGS 10-183n
Name/Address Changes: CGS 10-183n
Reimbursement Claim--for Day Care Centers: 7-CFR 226.11(b)
Reimbursement Claim--Day Care Homes:
Semi-Annual Revenue & Cost Expend Rpt:
REIMB CLAIM--NAT SCH LUNCH, BRKFST & SPEC MILK: 7-CFR 210.11,
Application--School Assistance
Qurtrly Pmnt Form=-Prvt Occup Schl
Town Report of Monthly Deposit & Member Terminations:
Town
Town
Town
7-CFR 226.12(b), 226.13(g)
7-CFR 210.15, 220.13(i)
215.8
in Fedrlly Affected Areas: PL 81-874
Stud Protectn Fund: CGS 10-14
CGS 10-183n
Report of Monthly Leave Payments: CGS 10-183n
Report of Monthly Instal iment Payments: CGS 10-183n
Report of Annual Substitute Service: CGS 10-183v
Report of Changes During the School Year: CGS 10-183n
Report of
Report of
Statement
Statement
Statement
Superintendents (CAPS);
F-Federal; B-Both
Substitute Service by Retired Teachers: CGS 10-183n
Teacher's Absences & Leaves: CGS 10-183n
of Payment Plan--Period Certain: CGS 10-183
of Payment Plan--Co-Participant: CGS 10-183
of Payment Plan--Normal: CGS 10-183
B-Some Superintendents; C-Others;
State
Contact Person
Annette McCall |
Stella Kulagowski
Stella Kulagowski
Maureen Staggenborg
Maureen Staggenborg
Janet H. Bantly
Janet H. Bantly
Mark R. Stange
Priscilla Boivin
Maria Todd
Maria Todd
Dorothy Holmes
Dorothy Holmes
Stella Kulagowski
Gail Barton
Stella Kulagowski
Gail Barton
Gail Barton
Gail Barton
a RII SVEN INEE a tn Ll lh tin me Si tl es OS mbit
Telephage
nuns ff)
566-5959
566-2875
566-2875
566-3195
566-3195
566-3195
566-3195
566-3430
638-4159
566-3889
566-3889
566-5520
566-5520
566-2875
566-5285
566-2875
566-5285
566-5
566-5285
D-Other Agency Forms; E-Not annual
nN
—
Date
Due
State
2- 5M
2-10M
2-10M
2-15M
2-15M
2-15M
2-15
2-15
2-28M
2-28M
2-28M
2-28M
2-28M
2-28M
2-28M
2-28M
2-28M
2-28M
Designations--Form Type:
S-State;
Local
Contact
Person
Sup't
BdEduc
BdEduc
Sponsr
Sponsr
Sup't
Sup't
Sup't
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
Form
Type
A
D
D
Cc
C
A
A
A
D
D
D
D
D
D
D
D
D
D
Need:
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part II
Monthly Calendar of Forms
FEBRUARY
Form
Need Number
B ED-111
TRB19A
TRB19B
ED-086
ED-088
ED-103
ED-24Y
ED-245
TRBO8A
TRBOSE
TRBO8S
TRB10
TRB10A
TRB10OL
TRB33C
TRB33D
TRB33N
S
S
F
;
F
B
B
S
S TRBOSC
S
S
S
S
S
S
S
S
A-Al| Superintendents (CAPS);
Form Name: Justification
STATUS OF CASH REPORT--PREPAYMENT GRANT PROGRAMS: R=34,-74, -T4c, -74d
Transfer Form: CGS 10-183n
Name/Address Changes: CGS 10-183n
Reimbursement Claim--for Day Care Centers: 7-CFR 226.11(b)
Reimbursement Claim--Day Care Homes: 7-CFR 226.12(b), 226.13(gq)
REIMB CLAIM--NAT SCH LUNCH, BRKFST & SPEC MILK: 7-CFR 210.11, 215.8
GRANT APPLICATION-=ADULT EDUCATION: CGS 10-67,-73b, PL 100-297
GRANT APPLICATION REVISION--ADULT EDUCATION: CGS 10-69, PL 100-297
Town Report of Monthly Deposit & Member Terminations: CGS 10-183n
Town Report of Monthly Leave Payments: CGS 10-183n
Town Report of Monthly Installment Payments: CGS 10-183n
Town Report of Annual Substitute Service: CGS 10-183v
Report of Changes During the School Year: CGS 10-183n
Report of Substitute Service by Retired Teachers: CGS 10-183n
Report of Teacher's Absences & Leaves: CGS 10-183n
Statement of Payment Plan--Period Certain: CGS 10-183
Statement of Payment Plan--Co-Participant: CGS 10-183
Statement of Payment Plan--Normal: CGS 10-183
F-Federal; B-Both
B-Some Superintendents; C-Others; D-Other Agency Forms;
State
Contact Person
Annette McCall |
Stella Kulagowski
Stella Kulagowski
Maureen Staggenborg
Maureen Staggenborg
Janet H. Bantly
Roberta Pawloski
Roberta Pawloski
Maria Todd
Maria Todd
Dorothy Holmes
Dorothy Holmes
Stella Kulagowski
Gail Barton
Stella Kulagowski
Gail Barton
Gail Barton
Gail Barton
Teleph
numb fll)
566-5959
566-2875
566-2875
566-3195
566-3195
566-3195
638-4169
638-4160
566-3889
566-3889
566-5520
566-5520
566-2875
566-5285
566-2875
566-5285
566-5285
266-524
E-Not annual
nN
nN
Date Local
Due Contact
State Person
Sup't
3- 5M Sup't
3-10M BdEduc
3-10M BdEduc
3-15M Sponsr
3-15M Sponsr
3-15M Sup't
3-15 4
3-31M BdEduc
3-31M BdEduc
3-31M BdEduc
3-31M BdEduc
3-31M BdEduc
3-31M BdEduc
3-31M BdEduc
3-31M BdEduc
3-31M BdEduc
3-31M BdEduc
*Sup"t., V.T.
Designations--Form Type: A-All Superintendents (CAPS); B-Some Superintendents;
S-State;
Form
Type
A
A
D
D
C
Cc
A
A
D
D
D
D
D
D
D
D
D
D
Dir,,
Need:
Form
Need Number
S ED-031
ED-111
TRB19A
TRB19B
ED-086
ED-088
ED-103
ED-404
TRBOSA
TRBOSE
TRBO8S
TRB10
TRB10A
TRB10OL
TRB33C
TRB33D
B
S
S
F
p
r
B
S
S TRBOSC
S
S
s
S
S
s
s
S TRB33N
Comm. Col. Pres.,
F-Federal;
Form
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part II
Monthly Calendar of Forms
MARCH
Name: Justification
TEACHER ALLOCATION REPORT: CGS 10-65(a), -67(b), -76f(h), -217a(b)
STATUS OF CASH REPORT--PREPAYMENT GRANT PROGRAMS: R-34,-74,-TlUc, -74d
Transfer Form: CGS 10-183n
Name/Address Changes: CGS 10-183n
Reimbursement Claim=--for Day Care Centers: 7-CFR 226.11(b)
Reimbursement Claim--Day Care Homes: 7-CFR 226.12(b), 226.13(g)
REIMB CLAIM-=NAT SCH LUNCH, BRKFST & SPEC MILK: 7-CFR 210.11,
COMPLETER
215.8
FOLLOW-UP REPORT FOR VOC ED PGM: CGS 10-95,-97, PL 95-524
Town Report of Monthly Deposit & Member Terminations: CGS 10-183n
Town Report of Monthly Leave Payments: CGS 10-183n
Town Report of Monthly Instal iment Payments: CGS 10-183n
Town Report of Annual
Report of
Report of
Report of
Statement
Statement
Statement
Tech.
Substitute Service: CGS 10-183v
Changes During the School Year: CGS 10-183n
Substitute Service by Retired Teachers: CGS 10-183n
Teacher's Absences & Leaves: CGS 10-183n
of Payment Plan--Period Certain: CGS 10-183
of Payment Plan--Co-Participant: CGS 10-183
of Payment Plan--Normal: CGS 10-183
Col. Pres., and Other Agencies.
B-Both
State
Contact Person
Mark R. Stange
Annette McCall
Stella Kulagowski
Stella Kulagowski
Maureen Staggenborg
Maureen Staggenborg
Janet H. Bantly
William Choquette
Maria Todd
Maria Todd
Dorothy Holmes
Dorothy Holmes
Stella Kulagowski
Gail Barton
Stella Kulagowski
Gail Barton
Gail Barton
Gail Barton
Telephqg
nunbe
566-4861
566-5959
566-2875
566-2875
566-3195
566-3195
566-3195
566-3444
566-3889
566-3889
566-5520
566-5520
566-2875
566-5285
566-2875
566-5285
566-5285
ase
C-Others; D-Other Agency Forms; E-Not annual
nN
w
Date
Due
State
4- 5M
4-10M
4-10M
4-15M
4-15M
4-15
4-15M
L4-30Q
4-30M
L4-30M
4-30M
4-30M
4-30M
4=-30M
4-30M
4-30M
4-30M
4-30M
Local
Contact
Person
Sup't
BdEduc
BdEduc
Sponsr
Sponsr
Sponsr
Sup't
Dirctr
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
Form
Type
A
D
D
C
Cc
Cc
A
C
D
D
D
D
D
D
D
D
D
D
Need:
Form
Need Number
B
“
w
o
n
o
n
u
nu
n
n
nu
n
m
»
Mw
m
M
mM
Mm
Mm
o
®
u
o
w
Designations--Form Type: A-All
S-State;
ED-111
TRB19A
TRB19B
ED-086
ED-088
ED-094
ED-103
BAE-004
TRBO8A
TRBO8C
TRBOSE
TRBO8S
TRB10
TRB10A
TRB10OL
TRB33C
TRB33D
TRB33N
Form
STATUS OF CASH REPORT=--PREPAYMENT GRANT PROGRAMS: R-34,-74,-74c, -7u4d
Transfer
Name/Addr
Reimburse
Reimburse
Compliance Agreement--Summer Food Service Program: 7-CFR 225.19(a)
REIMB CLAIM--NAT SCH LUNCH, BRKFST & SPEC MILK: 7-CFR 210.11, 215.8
Qurtriy P
Town Repo
Town Repo
Town Repo
Town Repo
Report of
Report of
Report of
Statement
Statement
Statement
Superintendents (CAPS); B-Some Superintendents; C-Others;
F-Federal; B-
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part II
Monthly Calendar of Forms
APRIL
Name: Justification
Form: CGS 10-183n
ess Changes: CGS 10-183n
ment Claim--for Day Care Centers: 7-CFR 226.11(b)
ment Claim--Day Care Homes: 7-CFR 226.12(b), 226.13(9g)
mnt Form=--Prvt Occup Schl Stud Protectn Fund: CGS 10-1U4i
rt of Monthly Deposit & Member Terminations: CGS 10-183n
rt of Monthly Leave Payments: CGS 10-183n
rt of Monthly Installment Payments: CGS 10-183n
rt of Annual Substitute Service: CGS 10-183v
Changes During the School Year: CGS 10-183n
Substitute Service by Retired Teachers: CGS 10-183n
Teacher's Absences & Leaves: CGS 10-183n
of Payment Plan--Period Certain: CGS 10-183
of Payment Plan--Co-Participant: CGS 10-183
of Payment Plan--Normal: CGS 10-183
Both
D-Other Agency Forms;
State
Contact Person
Annette McCall |
Stella Kulagowski
Stella Kulagowski
Maureen Staggenborg
Maureen Staggenborg
Maureen Staggenborg
Janet H. Bantly
Priscilla Boivin
Maria Todd
Maria Todd
Dorothy Holmes
Dorothy Holmes
Stella Kulagowsk i
Gail Barton
Stella Kulagowski
Gail Barton
Gail Barton
Gail Barton
Telephone
Numbe
566-59
566-2875
566-2875
566-3195
566-3195
566-3195
566-3195
638-4159
566-3889
566-3889
566-5520
566-5520
566-2875
566-5285
566-2875
566-5285
566-5285
Sa
E-Not annual
EE
Y
E
D
T
i
e
t
ac
te
Date
Due
State
55M
5-8
5-8
5-10M
5-10M
5=15T
5-157
5-15M
5=15M
5-15
5-15
5-15M
5-15
5-15
5«15
5-19
5-26
5-26
5-31M
5-31M
5-31M
5-31M
5-31M
5-31M
Local
Contact
Person
Sup't
Sup't
Sup't
BdEduc
BdEduc
Sup't
Sup't
Sponsr
Sponsr
Sponsr
Sponsr
Sup't
Prncp|
Sup't
Sup't
*
*
*
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
*Sup't., v.T.
Designations--Form Type: A-All Superintendents (CAPS); B-Some Superintendents; C-Others;
S-State;
Form
Type
A
B
B
D
D
A
A
C
Cc
Cc
C
A
C
A
B
A
A
A
D
D
D
D
D
D
Dir.,
Need:
Form
Need Number
B ED-111
ED-008B
ED-008C
TRB19A
TRB198B
ED-025
ED-027
ED-086
ED-088
ED-090
ED-091
ED-103
ED-169
ED-340
ED-400C
ED-400A
ED-400B
TRBOSA
TRBO8C
TRBOSE
TRBO8S
TRB10
S TRB10A
Comm. Col.
s
S
S
S
s
S
F
F
F
;
F
S ED-159A
s
F
B
B
B
S
S
S
S
S
Pres.,
F-Federal;
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part 11
Monthly Calendar of Forms
MAY
Form Name: Justification
STATUS OF CASH REPORT--PREPAYMENT GRANT PROGRAMS: R-34,-74,-T4c,=74d
Mental Health Facilities Grant: CGS 10-76d(e)(5)
Mental Health Facilities Grant: CGS 10-76d(e)(5)
Transfer Form: CGS 10-183n
Name/Address Changes: CGS 10-183n
PUPIL DATA REPORT: CGS 10-261(a)
REGIONAL SCHOOLS PUPIL DATA REPORT (ED-025R): CGS 10-261,-53
Reimbursement Claim=--for Day Care Centers: 7-CFR 226.11(b)
Reimbursement Claim--Day Care Homes: 7-CFR 226.12(b), 226.13(g)
Application--Summer Food Service Program: 7-CFR 225.8
Site Sheet--Summer Food Service Program: 7-CFR 225.8(1)
REIMB CLAIM--NAT SCH LUNCH, BRKFST & SPEC MILK: 7-CFR 210.11, 215.8
Nonpublic School Report: CGS 10-188, -217a, =-281
PROFESSIONAL DEVELOPMENT GRANT: CGS 10-155dd
Certification Form--Handicapped Studnts in Voc Educ: PL 98-524
IN VOCATIONAL PROGRAMS: PL 98-524
VOC EDUC SECONDARY ENROLLMENT & COMPLETION RPT: CGS 10-4, PL 98-524
DISADV & LMTED ENGL PROF STUDENTS
VOC EDUC POST-SECONDRY ENRLLMNT & COMPLETN RPT: CGS 10-4, PL 98-524
Town Report of Monthly Deposit & Member Terminations: CGS 10-183n
Town Report of Monthly Leave Payments: CGS 10-183n
Town Report of Monthly Installment Payments: CGS 10-183n
Town Report of Annual Substitute Service: CGS 10-183v
Report of Changes During the School Year: CGS 10-183n
Report of Substitute Service by Retired Teachers: CGS 10-183n
Tech. Col. Pres., and Other Agencies.
B-Both
State
Contact
Annette
Mark R.
Mark R.
Person
McCall |
Stange
Stange
Stella Kulagowski
Stella Kulagowski
Mark R.
Mark R.
Maureen
Maureen
Maureen
Maureen
Janet H.
Mark R.
Dick vai
Stange
Stange
Staggenborg
Staggenborg
Staggenborg
Staggenborg
Bantly
Stange
| lancourt
Judith Thompson
William Choquette
William Choquette
William Choquette
Maria Todd
Maria Todd
Dorothy Holmes
Dorothy Holmes
Stella Kulagowski
Gail Barton
Telephone
Number
566-5959 ga
( 566-4861
566-4861
566-2875
566-2875
566-4861
566-4861
566-3195
566-3195
566-3195
566-3195
566-3195
566-4861
566-5750
566-7369
566-34ul
566-3u44
566-3444
566-3889
566-3889
566-5520
566-5520
566-2875
566-5285
D-Other Agency Forms; E-Not annual
.
EE
Bo
87)
.
nN
ol
Date Local
Due Contact Form
Type State Person
5-31M BdEduc
5-31M BdEduc
5-31M BdEduc
5-31M BdEduc
D
D
D
D
Need:
Form
Need Number
S
S
S
S
Designations--Form Type:
S-State;
TRB10OL
TRB33C
TRB33D
TRB33N
A-All Superintendents (CAPS); B-Some Superintendents;
F-Federal; B-Both
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part II
Monthly Calendar of Forms
MAY (Cont.)
Form Name: Justification
Report of Teacher's Absences & Leaves: CGS 10-183n
Statement of Payment Plan--Period Certain: CGS 10-183
Statement of Payment Plan--Co-Participant: CGS 10-183
Statement of Payment Plan--Normal: CGS 10-183
State
Contact Person
Stella Kulagowski
Gail Barton
Gail Barton
Gail Barton
Telephone
Number
566-2875
i
566-5285
566-5285
C-Others; D-Other Agency Forms; E-Not annual
bs
LR
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A
R
A
E
E
S
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F
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CA
SS
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oa
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W
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oi
¥
ft
Xa
p
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S
©
Date Local
Due Contact Form
State Person
6- 1
6-1
6- 1
8 2
6- 5M
6-10M
6-10M
6-10M
6-15M
6-15M
6-15M
6-15
6-15
6-15E
6-15E
6~15E
Designations--Form Type: A-All Superintendents
S-State; F-Federal; B-Both
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
Dirctr
Sup't
Dirctr
Dirctr
Sup't
Sponsr
BdEduc
BdEduc
Sponsr
Sponsr
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
Type
A
B
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>
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0
0
0
0
0
3
0
0
0
0
0
0
0
9
5
0
o
>
Need:
Form
Need Number
B ED-203
ED-203a
ED-203b
ED-204
ED-205
ED-206
ED-211
ED-452
ED~-512
FRC-004
ED-310
FRC-003
ED-092
TRB19A
TRB198B
ED-086
ED-088
ED-103
ED-150
ED-155
,
:
F
B
F
F
F
F
F
S
S
B ED-111
"
3
s
F
F
F
S
S
B ED-215
a ED-216A Application for Grant Approval (Five or Fewer Children): PL 89-313
B ED-216B Application for Grant Approval (Six or more children): PL 89-313
Connecticut State Department of Education
Form Name:
LOCAL SCHOOL DIST APPLN FOR COMP ED GRANTS: CGS 10-14m-r, PL 100-297
LOCAL SCHOOL DIST APPLN FOR CAPITAL EXPENSES GRANT: PL 100-297
Chapter 1 Neglected & Delinquent Children Appin (State): PL 100-297
Chapter 1 Evaluation Rprt--Neglected & Del inqunt Chidrn: PL 100-297
Compensatory Program Project Info Summary: CGS 10-140(b), PL 100-297
Application--Migrant Education Grants-Chapter 1 ECIA: PL 100-297
Eisenhower Math & Science Education Act, Title 11:
Debt Service Claim Form: CGS 10-261a
Part |
Data Acquisition Plan 1989-90
Monthly Calendar of Forms
J UNE
Justification
PL 100-297
Application: Early Childhood Network Grant: PL 99-457
Application: Birth to Three Continuation Grant: PL 94-142
Application: Approval of Occupational Schools: CGS 10-7a-1
Letter of Financial Commitment and Responsibility: CGS 10-7c(a)(2)
STATUS OF CASH REPORT=--PREPAYMENT GRANT PROGRAMS: R=34,-74,-74c, -74d
Reimbursement Claim--Summer Food Service Program: 7-CFR 225.11(c)
Transfer Form: CGS 10-183n
Name/Address Changes: CGS 10-183n
Reimbursement Claim--for Day Care Centers: 7-CFR 226.11(b)
Reimbursement Claim--Day Care Homes: 7-CFR 226.12(b), 226.13(9g)
REIMB CLAIM--NAT SCH LUNCH, BRKFST & SPEC MILK: 7-CFR 210.11, 215.8
Teacher Evaluation Program Implementation Rpt: CGS 10-151b, -155ff
ENUMERAT ION REPORT: CGS 10-249 to =-250
EDUCATION OF THE HANDICAPPED-Part B: PL 94-142
(CAPS); B-Some Superintendents; C-Others; D-Other Agency Forms;
State
Contact Person
Diana Whitelaw
Diana Whitelaw
Diana Whitelaw
Carlos Martinez
Carlos Martinez
Carol Gilchrist
Judy Carson
Mark R. Stange
Kay Halverson
Kay Halverson
Priscilla Boivin
Priscilla Boivin
Annette McCall
Maureen Staggenborg
Stella Kulagowski
Stella Kulagowski
Maureen Staggenborg
Maureen Staggenborg
Janet H. Bantly
Gloria Williams
Richard J. Cloud
David Murphy
David Murphy
David Murphy
Telephone
Number
638-4224
638-4224
638-422y
566-4377
566-4377
638-4225
566-2931
566-4861
566-5670
566-5670
638-4159
638-4159
566-5959
566-3195
566-2875
566-2875
566-3195
566-3195
566-3195
566-7258
566-1685
638-4240
638-4240
638-4240
E-Not annual
Date
Due
Local
State Person
6-15E
6-15E
6-15
6-15
6-15
6-15
6-30
6-30
6-30
6-30M
6-30M
6-30M
6-30M
6-30M
6-30M
6-30M
6-30M
6-30M
6-30M
Designations--Form Type: A-Al|
S-State;
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
Contact Form
Type
B
PD
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0
OO
Q
D
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OO
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Need:
Form
Need Number
B ED-216C
ED-217
ED-222
ED-291
ED-292
ED-515
ED-040
ED-210
TRBO8
TRBOSA
TRB0O8C
TRBOSE
TRBO8S
TRB10
TRB10A
TRB1OL
TRB33C
TRB33D
N
L
h
n
N
n
B
N
T
s
ty
T
Y
om
TRB33N
Superintendents (CAPS); B-Some Su
F-Federal;
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part II
Monthly Calendar of Forms
J UNE (Cont.)
Form Name: Justification
Application for Grant Approval (State Oper/Supp Agencs): PL 89-313
Application: Preschool Handicapped Entitlement Grant: PL 99-457
GRANT APPLICATION: CHAPTER 2: PL 100-297
Annual Driver Education Report: CGS 10-24
Approval of School Driver Education Program: CGS 10-24
Teacher Evaluation Plan Report Form: CGS 10-151b, -155ee, =-155ff
Application for Proposed School Building Project: CGS 10-283
Drug Free Schools and Communties Act of 1986: PL 99-570
Annual Report of Retirement Deductions: CGS 10-183n
Town Report of Monthly Deposit & Member Terminations: CGS 10-183n
Town Report of Monthly Leave Payments: CGS 10-183n
Town Report of Monthly Instaliment Payments: CGS 10-183n
Town Report of Annual Substitute Service: CGS 10-183v
Report of Changes During the School! Year: CGS 10-183n
Report of Substitute Service by Retired Teachers: CGS 10-183n
Report of Teacher's Absences & Leaves: CGS 10-183n
Statement of Payment Plan--Period Certain: CGS 10-183
Statement of Payment Plan--Co-Participant: CGS 10-183
Statement of Payment Plan--Normal: CGS 10-183,
B-Both
State
Contact Person
David Murphy
Kay Halverson
Joan Shoemaker
Gregory C. Kane
Gregory C. Kane
Gloria Williams
William D. Guzman
Judy Carson
Betty Bazin
Maria Todd
Maria Todd
Dorothy Holmes
Dorothy Holmes
Stella Kulagowski
Gail Barton
Stella Kulagowski
Gail Barton
Gail Barton
Gail Barton
Telephone
Number
638-4240
566-5670
638-4205
638-4067
638-4067
566-7258
566-7546
566-2931
566-2875
566-3889
566-3889
566-5520
566-5520
566-2875
566-5285
566-2875
566-5285
566-5285
566-5285
perintendents; C-Others; D-Other Agency Forms; E-Not annual
O
C
Date Local
Due Contact Form
State
7- 1
= 1
7- 1
7- 5M
7- 6
7-10M
7-10M
7-10M
7-15M
7-15M
7-158
7-15M
7-15
7-31Q
7-31M
7-31M
7-31M
7-31M
7-31M
7-31M
7-31M
Person
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
Sponsr
BdEduc
BdEduc
Sponsr
Sponsr
Sponsr
Sup't
Sup't
Dirctr
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
Type
A
PD
0
0
0
OO
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0
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33
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Need Number
S
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nu
nu
uv
vu
vw
nv
Mv
Mm
mM
TM
Mm
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LI
2 I
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+
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E
7
TR
7,
J
7
J
7
JO
7
S
ED-003
ED-O08A
ED-099
ED-147
ED-229
ED-511
ED-111
ED-518
ED-092
TRB19A
TRB19B
ED-086
ED-088
ED=-102
ED-103
ED-180
BAE-004
TRBOSA
TRBO8C
TRBOSE
TRBO8S
TRB10
TRB10A
TRB1OL
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part II
Monthly Calendar of Forms
J
Form Name: Justification
U LY
TEACHER/ADMINISTRATOR NEGOTIATIONS: CGS 10-153a
Mental Health Facilities Grant: CGS 10-76d(e)(5)
Agreement for Child Nutrition Programs: PL 95-166
SCHOOL DISTRICT CALENDAR SURVEY: CGS 10-15,-16,-161
Bilingual Education Grant Application: CGS 10-179
Local Education Goals Report: CGS 10-220 (b)
STATUS OF CASH REPORT--PREPAYMENT GRANT PROGRAMS: R-34,-74,~74c, -74d
AIDS EDUCATION SURVEY: 42 U.S.C. 241 (a)
Reimbursement Claim--Summer Food Service Program: 7-CFR 225.11(c)
Transfer Form: CGS 10-183n
Name/Address Changes: CGS 10-
Reimbursement Claim--for Day Care Centers: 7-CFR 226.11(b)
Reimbursement Claim--Day Care Homes: 7-CFR 226.12(b), 226.13(9g)
Semi-Annual Revenue & Cost Expend Rpt: 7-CFR 210.15, 220.13(i)
REIMB CLAIM-=-NAT SCH LUNCH, BRKFST & SPEC MILK: 7-CFR 210.13, 215.8
REPORT OF THREATS AND ASSUALTS IN SCHOOLS: CGS 10-2339
Qurtrly Pmnt Form--Prvt Occup Schl Stud Protectn Fund: CGS 10-14
Town Report of Monthly Deposit & Member Terminations: CGS 10-183n
183n
Town Report of Monthly Leave Payments: CGS 10-183n
Town Report of Monthly Installment Payments: CGS 10-183n
Town Report of Annual Substitute Service: CGS 10-183v
Report of Changes During the
Report of Substitute Service by Retired Teachers: CGS 10-183n
Report of Teacher's Absences
Designations--Form Type: A-All Superintendents (CAPS); B-Some
S-State; Need: F-Federal; B-Both
School Year: CGS 10-183n
& Leaves: CGS 10-183n
State
Contact Person
Leslie Williamson
Mark R. Stange
Janet H. Bantly
Thomas F. Breen
Angie Soler Galiano
Elizabeth Schmitt
Annette McCall
Elaine Brainerd
Maureen Staggenborg
Stella Kulagowski
Stella Kulagowski
Maureen Staggenborg
Maureen Staggenborg
Janet H. Bantly
Janet H. Bantly
Thomas F. Breen [11
Priscilla Boivin
Maria Todd
Maria Todd
Dorothy Holmes
Dorothy Holmes
Stella Kulagowski
Gail Barton
Stella Kulagowski
Telephone
Number
566-2135
566-4861
566-3195
566-5635
638-4264
566-1961
566-5959
638-4227
566-3195
566-2875
566-2875
566-3195
566-3195
566-3195
566-3195
566-5635
638-4159
566-3889
566-3889
566-5520
566-5520
566-2875
566-5285
566-2875
Superintendents; C-Others; D-Other Agency Forms; E-Not annual
State Person Need Number
7-31M BdEduc
7-31M BdEduc
7-31M BdEduc
6¢
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part i!
Monthly Calendar of Forms
JULY (Cont.)
Name: Justification
of Payment Plan--Period Certain: CGS 10-183
of Payment Plan--Co-Participant: CGS 10-183
of Payment Plan--Normal: CGS 10-183j
Designations--Form Type: A-All Superintendents (CAPS); B-Some Superintendents; C-Others;
B-Both F-Federal;
Contact Person
D-Other Agency Forms; E-Not annual
ml a Dd mci Th oa. Ps . Th . Fri) FO Sr Sade in deo a ten Ne ae te A te at nlite Sten iain. 3 4. Submittal
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part 11
Monthly Calendar of Forms
AUGUST Date Local
Due Contact Form Form
State Telephor
State Person Type Need Number Form Name: Justification
Contact Person Number Sup't A B ED-241 ADULT EDUCATION SUMMARY REPORT: CGS 10-67,-73b, PL 100-297 Roberta Pawloski 638-416 Sup't ED-111 STATUS OF CASH REPORT--PREPAYMENT GRANT PROGRAMS: R-34,-74,-74c,~74d Annette McCall | 566-59¢ Sponsr ED-092 Reimbursement Claim--Summer Food Service Program: 7-CFR 225.11(cC) Maureen Staggenborg 566-31¢ BdEduc
BdEduc
TRB19A Transfer Form: CGS 10-183n
Stella Kulagowski 566-287 TRB19B Name/Address Changes: CGS 10-183n
Stella Kulagowski 566-287 Sup't ED-053 Site Analysis Form: CGS 10-286d
Richard Krissinger 566-26¢ Sponsr ED-086 Reimbursement Claim--for Day Care Centers: 7-CFR 226.11(b) Maureen Staggenborg 566-319 Sponsr ED-088 Reimbursement Claim--Day Care Homes: 7-CFR 226.12(b), 226.13(g) Maureen Staggenborg 566-31¢ Sup't ED-103 REIMB CLAIM-=-NAT SCH LUNCH, BRKFST & SPEC MILK: 7-CFR 210.11, 215.8 Janet H. Bantly 566-31¢ Sup't ED-002 CERTIFICATE OF COMPLIANCE WITH LAW: CGS 10-260, -220 Mark Stapleton 566-382
BdEduc TRBO8C Town Report of Monthly Leave Payments: CGS 10-183n Maria Todd 566-388 BdEduc TRBOBE Town Report of Monthly Installment Payments: CGS 10-183n Dorothy Holmes 566-552 BdEduc TRBO8S Town Report of Annual Substitute Service: CGS 10-183v Dorothy Holmes 566-552 BdEduc TRB10 Report of Changes During the School Year: CGS 10-183n Stella Kulagowski 566-287 BdEduc TRB10A Report of Substitute Service by Retired Teachers: CGS 10-183n Gail Barton | 566-528 BdEduc TRB10L Report of Teacher's Absences & Leaves: CGS 10-183n Stella Kulagowski 566-287 BdEduc TRB33C Statement of Payment Plan--Period Certain: CGS 10-183 Gail Barton 566-528 BdEduc TRB33D Statement of Payment Plan--Co-Participant: CGS 10-183 Gail Barton 566-528
A
C
D
D
B
Cc
Cc
A
A
BdEduc D
D
D
D
D
D
D
D
D
D
B
F
S
S
S
F
F
F
S
S TRBOBA Town Report of Monthly Deposit & Member Terminations: CGS 10-183n Maria Todd 566-388
S
S
S
S
S
S
S
S
S BdEduc TRB33N Statement of Payment Plan--Normal: CGS 10-183 Gail Barton 566-528
Designations=-Form Type: A-All Superintendents (CAPS); B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual Need: S-State; F-Federal; B-Both
TAT PERE STI Or, Sl PANS OGar | cdmin
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part II
» Monthly Calendar of Forms
As Required Date Local
rr) Due Contact Form Form
State Telephond
State Person Type Need Number Form Name: Justification
Contact Person Number AsReq Dirctr C S BAE-001 Out-of-State Prvt Occptnl Schils: Schl Info for Permit: CGS 10-7i Priscilla Boivin 638-4159 AsReq Dirctr C S BAE-002 Out-of-State Prvt Occptnl Schls: Representative Info: CGS 10-7i Priscilla Boivin 638-4159 AsReq Dirctr C S BAE-003 Out-of-State Prvt Occptnl Schls: Receipts Deposit: CGS 10-7i Priscilla Boivin 638-4159 AsReq Sup't B F DREA100SPupi| Counts for Funding under PL 94-142 George T. White 566-3461 AsReq Sup't B F DREA100UPupi| Counts for Funding under PL 89-313 George T. White 566-3461
AsReq Dirctr Cc S DREA502 Students Identified or Receiving Educ, by Site Location George T. White 566-3461 AsReq Sup't B S DREA680 Excess Cost Grant Placements
George T. White 566-3461 AsReq Sup't B S DREA690 Students Placed Out by a State Agency Who Require Spec Education George T. White 566-3461 AsReq Sup't B S DREA691 State Agency Placements, Residential, Spec Educ in School District George T White 566-3461 AsReq Sup't B S DREA692 Students Req Educ Only, St Agncy in Prvt Resid Facility George T. White 566-3461 $0 AsReq Sup't B S ED-004 Priority School District Program: CGS 10-266p-r Theodore S. Sergi 638-4000 AsReq Sup't A S ED-014 MINIMUM EXPENDITURE REQUIREMNT PRELIM COMPLIANCE CHECK: CGS 10-262e Martin Hollis 566-3431 AsReq Sup't B S ED-025A Pupil Data Adjustment Form: CGS 10-261(a) Mark R. Stange 566-4861
AsReq Sup't B S ED-026 Pup’! Data Conflict Form: CGS 10-261 Mark R. Stange 566-4861
AsReq Sup't B S ED-027A Pupil Data Adjustment Form: CGS 10-261(a) Mark R. Stange 566-4861 AsReq Sup't B S ED-O41 Notice of Applicant's Funding: CGS 10-283a William D. Guzman 566-7546 AsReq Sup't B S ED-042 Request for Review of Final Plans: CGS 10-291 Richard Krissinger 566-2688
AsReq Sup't B S ED-043 Request for Est Int & Prin Bond Payment: CGS 10-287h William D. Guzman 566-7546
AsReq Sup't B S ED-O4Y4 Request for School Building Grant: CGS 10-287(d) William D. Guzman 566-7546
AsReq Sup't B S ED-045 Notice of Bond Issue: CGS 10-287
William D. Guzman 566-7546
AsReq Sup't B S ED-047 Notice of Short Term Note: CGS 10-289a William D. Guzman 566-7546
AsReq Sup't B S ED-048 Notice of Start of Construction: CGS 10-284 William D. Guzman 566-7546
AsReq Sup't B Ss ED-072 Notice of Intent to Renew Temporary Notes: CGS 10-287f William D. Guzman 566-7546
AsReq Sup't B S ED-073 Notice of Temporary Note Issue: CGS 10-287h William D. Guzman 566-7546
Designations--Form Type: A-All| Superintendents (CAPS);
Need: S-State; F-Federal; B-Both
B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual
o
e
State
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
Designations--Form Type:
S-State;
Local
Contact Form
Type Person
Bidginsp C
Bidginsp C
Sup't
Sup't
FdSMC
Sponsr
Sponsr
Sponsr
Sponsr
Sponsr
Sup't
Sup't
Sup't
Sup't
Sup't
Sup't
Applcnt
Emplyr
App/Emp
App/Emp
Emp/App
Emplyr
Applcnt
App/Emp
B
A
Cc
Cc
Cc
Cc
A
Cc
A
B
A
A
A
E
Cc
Cc
Cc
Cc
Cc
Cc
C
Cc
Need:
Form
Need Number
S
s
s
s
F
s
F
F
s
F
B
s
B
F
F
s
S
s
8
s
S
8
s
s
ED-075A
ED-0758B
ED-075C
ED-076
ED-093
ED-095
ED-096
ED-098
ED-105
ED-109
ED-110
ED-114
ED-141
ED-142
ED-143
ED-149
ED-170
ED-171
ED-172
ED-173
ED-174
ED-175
ED-176A
ED-177
A-Al| Superintendents (CAPS); B-Some Superintendents; C-Others; D-
F-Federal;
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part II
> Monthly Calendar of Forms
As Required (Cont.)
Form Name: Justification
Area Asbestos Inspection Report: CGS 10-292b
Schoo! Facility Asbestos Inspection Report: CGS 10-292b
School District Asbestos Inspection Report: CGS 10-292b
ANNUAL ASBESTOS MANAGEMENT PLAN UPDATE: CGS 10-292b
Application for Vendor Registration: 7-CFR 225.16(c) (1)
Estimated Meal Counts--School Breakfast: CGS 10-266w
Certfication Letter--Summer Food Serv Prg--Sites Visited: 7-CFR 225
Civil Rights Survey--Preaward Comp Rev: 7-CFR 225.9(h), 226.6(e)
LUNCH COUNT RPRT--CHILD NUTRIT PROG: CGS 10-266w, 7-CFR 220.9(e)(3)
Application--Start-up Paymnts--Child Care Prg: 7-CFR 226.7(h),.12(b)
34-CFR 74.61(e)
Prepayment Grant Budget Request: PL 99-570
STATEMENT OF EXPENDITURE FED & STATE PREPAYT PROJS: R=-34,-73,-74
STATEMENT OF EXPEND CARRYOVER--FED PREPAYT PROJ: R-34,-73,-74
CASH FLOW PROJECTION STATEMENT:
LIQUIDATION OF OBLIGATIONS--FED PREPAYMENT PROJECTS: R=-34,-73,-74
Curriculum Survey: CGS 10-16b
Genrl Applctn: Teacher, Spec Serv Staff or Admin: CGS 10-1440, 145d
Stmnt of Professional Experience for Init Cert: CGS 10-1440, 145d
Request-Temp 90-day Certif-Altrnt Rte Candidates: CGS 10-1440, 145d
Request-Temporary Authorization for Minor Assignmnt: CGS 10-145b
Application-Special Substitute Teacher Authorization: CGS 10-145d
Application-Extension Substitute Authorization: CGS 10-145d
Request-Conversion of Standard or Permanent Cert: CGS 10-145b
Request-Durationa Shortage Area Permit: CGS 10-145b
B-Both
State
Contact Person
William D.
William D.
William D.
William D.
Maureen Staggenborg
Mary B.
Maureen Staggenborg
Maureen Staggenborg
Mary B.
Maureen Staggenborg
Guzman
Guzman
Guzman
Guzman
Ragno
Ragno
Annette McCall
Donald P.
Donald P.
Donald P,
Donald P.
Bernard
Bernard
Bernard
Bernard
George Coleman
Pat Scully
Pat Scully
Pat Scully
Pat Scully
Pat Scully
Pat Scully
Pat Scully
Pat Scully
Telephone
Number
566-7546
566-7546
566-7546
566-7546
566-3195
566-3195
566-3195
566-3195
566-3195
566-3195
566-5959
566-4989
566-4989
566-4989
566-4989
566-6645
566-1700
566-1700
566-1700
566-1700
566-1700
566-1700
566-1700
566-1700
Other Agency Forms; E-Not annual
—
—
. NERC SOT) US WER Sp . L : NE URE Sig SOE TEER AA U0 TX CFA (HO LW J VLA | TOT
di eh rH _
tt
Date
Due
State
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
AsReq
Local
Contact Form
Person
Emplyr
Applcnt
Applcnt
App/Emp
Sup't
Sup't
Sup't
Sup't
Sup't
Admins
Dirctr
Dirctr
Sup't
BdEduc
Sup't
Sup't
Sup't
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
BdEduc
Type
C
Cc
Cc
C
8
B
8
B
B
Cc
Cc
Cc
B
Cc
B
B
D
D
D
D
D
D
D
D
Need
wn
n
w
n
u
u
u
n
u
»
»
m
M
M
m
M
m
»
TM
TM
Y
W
TM
TM
TM
TM
T
M
M
Wm
S
Form
Number
ED-178
ED-184
ED-185
ED-186
ED-226
ED-234
ED-236
ED-237
ED-238
ED-301
ED-315
ED-316
ED-322
ED-501
ED-516
ED-517
OE-423
TRBOY
TRB14
TRB25
TRB25C
TRB27
TRB27V
TRB31A
Form
Bilingual
Request-Course Work Deficncy & CONNCEPT/CONNTENT Defrrl: CGS 10-145d
Application for Coaching Permit: CGS 10-149, -145d
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part 11
Monthly Calendar of Forms
As Required
Name: Justification
Educator: Rqst Deferral of Certif Rqrmnts:
(Cont. )
CGS 10-145d
Appl ication-Temp/Emergency Coaching Permit: CGS 10-149, -145d
Trans Pgm for Refugee Children--Application: PL 96-212, 99-605
Refugee Student Survey Report Form:
immigrant
Emergency
Emergency Immigrant Education Pgm--Annual
Statement
Appin for Aprvl to Train Vets/Elig Dpndts: Deg Grntg Schl: PL 89-358
Appin for Aprvl to Train Vets/Elig Dpndts: Non-Deg Grantg: PL 89-358
Student Survey Report Form:
immigrant Education Pgm--Grant Application:
PL 96-212, 99-605
PL 98-511
of Age (Working Papers): CGS 31-23
Progress Report:
PL. 98-511
PL 98-511
Grant Application for Regional Special Educatn Facility: CGS 10-76e
Preliminary Application for Aprvl, Regnl Vo-Ag Facility: CGS 10-284
Trans Prog for Refugee Children: Carry-over Grant Appl:
Emergncy Immgrnt Educ Pgm: Carry-over Grant Appl:
Application for Disaster Assistance: PL- 81-874
Teacher's Application for Retirement: CGS 10-183n
PL 99-605
Disability Application From Town for Member's Retirt: CGS 10-183n
Physician's Confidential Report: CGS 10-183n
Physician's Report of Illness: CGS 10-183n
Application for Withdrawal of Member's Deposits: CGS 10-183n
Application for Withdrawal of Voluntary Deposits: CGS 10-183n
Reinstatement Application: CGS 10-183n
State
Contact Person
Pat Scully
Pat Scully
Pat Scully
Pat Scully
George DeGeorge
George DeGearge
George DeGeorge
George DeGeorge
George DeGeorge
Natalie Rapoport
Edward Sampt
Edward Sampt
Alan J. White
Roger W. Lawrence
George DeGeorge
George DeGeorge
William D. Guzman
Gail Barton
Gail Barton
Gail Barton
Maria Todd
Suzanne Bock
David Seltzer
Stella Kulagowski
Telephone
Number
566-1700
566-1700
566-1700
566-1700
638-4253
638-4253
638-4253
638-4253
638-4253
638-4162
638-4164
638-4164
638-4247
638-4054
638-4253
638-4253
566-7546
566-5285
566-5285
566-5285
566-3889
566-3889
566-2875
566-2875
Designations--Form Type: A-All Superintendents (CAPS); B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual
S-State; Need: F-Federal; B-Both
Date
Due
State
AsReq
AsReq
AsReq
AsReq
Ww
Fe
Local
Contact Form
Person
BdEduc
BdEduc
BdEduc
BdEduc
Type
D
D
D
D
Need Number
S
S
S
S
Form
TRB3Y4
TRB34T
TRB53
TRB81
Connecticut State Department of Education
Data Acquisition Plan 1989-90
Part 11
Monthly Calendar of Forms
As Required (Cont.)
Form Name: Justification
Beneficiary Designation: CGS 10-183n
Trustee Designation: CGS 10-183n
Authorization of Formal Leave of Absence: CGS 10-183n
Authorization of Voluntary Deductions: CGS 10-183i
State
Contact Person
Jeannette Celani
Jeannette Celani
Stella Kulagowski
Suzanne Bock
Telephone
Number
566-528 2
566-5285
566-2875
566-3889
Designations--Form Type: A-All Superintendents (CAPS); B-Some Superintendents; C-Others; D-Other Agency Forms; E-Not annual
S-State; Need: F-Federal; B-Both