Instructions for Forms OS/CR-101-1 and OS/CR 102-1

    ® INSTRUCTIONS FOR FORM os/criflly 

” U.S. DEPARTMENT OF HEALTH, EDUCATION, ANDWELFARE 

Office for Civil Rights 

Washington, D.C. 

- 2 SCHOOL SYSTEM SUMMARY REPORT 

FALL 1969 ELEMENTARY AND SECONDARY SCHOOL SURVEY 

Due December 20, 1969 

  

General Instructions: The Fall 1969 Elementary and Secondary School Survey consists of two report forms: Forms OS/CR-101-1, 

School System Summary Report; and 102-1, Individual School Campus Report. See instructions for Item V for 

the definition of an individual school campus. The data reported should reflect the facts when enrollments and professional staff 

assignments can be considered stabilized, normally in the latter part of September. 

This report is due December 20, 1969. 

Please use a typewriter to complete the report. 

ITEMI. Use the school system name your State uses in its official listing of its school districts. The same name should be 

used in Item LA. of each Individual School Campus Report. 

ITEM IIL. Enter street address. 

ITEM III. Enter City, County, State and Zip Code. 

ITEMI1V. Enter the name of the Chief Administrative Officer (Superintendent) of the school system. 

ITEM V. Please enter the number of Individual School Campus Report Forms. A separate report must be completed for each : 

school campus in this system. If a school has classroom fagilities in more than one geographical location, an 

Individual School Campus Report Form must be filed for each separate location. 

ITEM VI. Fall, 1969 Student Enrollment in this system: 

Categories: Ethnic categories are considered mutually exclusive; count an individual in one ethnic category only. 

If there are no persons in a category, enter “0” for the category. Do NOT use percentages, average 

daily attendance, average daily membership, or year-end enrollments. 

Col. 1. American Indian. Persons considered by themselves, by the school. or by the community to be of 

American Indian origin. 

Col. 2. Negro. Persons considered by themselves, by the school, or by the community to be of African or 

Negroid origin. 

Col. 3. Oriental. Persons considered by themselves, by the school, or by the community to be of Chinese, 

Japanese, or other Oriental origin. 

Col. 4. Spanish Sumamed American. Persons considered by themselves, by the school, or by the community 

to be of Mexican, Puerto Rican, Central-American, Cuban, Latin-American, or other Spanish speaking 

origin. 

Col. 5. Enter the total number of students NOT included in Cols. 1-4. 

Col. 6. School System Totals. Add together all students entered in Cols. 1-5. 

LINE A. Cols. 1-6. Report the total system-wide elementary and secondary students in the appropriate ethnic 

categories. Each category on line VI. C. must be the total of similar categories reported on Individual 
‘School Campus Report Forms. 

LINE B. Cols. 1-6. Enter by ethnic category the number of students who reside within the boundaries of 

another public school district, but are enrolled in this school system. 

LINE C. Cols. 1-6. Enter by ethnic category the number of students who live within the boundaries of this 

school district and are enrolled in this school system. 

Each column in Line VI. C. must be the sum of column entries on Lines VI. A. and VI. B. 

ITEM VII. LINES A, Enter your best estimates of the number of students who reside within the boundaries of this school 

B, and C. district, but who are NOT enrolled in this school system. Please use the appropriate ethnic 

categories. 

ITEM VIII. FULL-TIME Professional Staff: 

LINE A. Please report the number of FULL-TIME Professional Staff members in this school system who are 
assigned to ONE school campus ONLY. (Sum of Individual School Campus Report Forms Item VIII. 
E.) If there are no persons in a category, enter “0” for the category. 

Do NOT use percentages, fractions, or full-time equivalents. 

Professional includes: Classroom teachers; principals; assistant principals; and those staff members 

who are supervisors of instruction, curricuium consultants, school librarians, non-classroom teachers 

(homebound, etc.), audio-visual staff, T.V. teachers, guidance counselors, and school psychologists. 

Do NOT include: Chief administrative officer of the school system (superintendent); para-professional 

staff members (teacher’s aides, student teachers, etc.); non-instructional staff members, such as at- 

tendance, business, financial, professional health personnel (doctors and nurses), school social 

workers, transportation, clerical, custodial, and food service personnel. 

LINE B. Enter by ethnic category the professional staff members who are full-time in this school system, but 

who are NOT full-time staff members at one particular school campus. These full-time professional 

staff members are NOT included in Item VIII on the Individual School Campus Report Forms. 

LINE C. Enter by ethnic category the number of FULL-TIME professional staff members in this school system 

by adding Items VIII A and B above. 

ITEM IX. Total by ethnic category the FULL-TIME Classroom Teachers who teach full-time at only one school campus in this 

system. (Sum of Individual School Campus Report Forms Items VIIA.) - 

ITEM X. OPTIONAL ITEM: Part-time Professional Staff members working less than full-time in this school system. 

SUBMISSION OF REPORT: This report, accompanied by Individual School Campus Report Forms from this system, 

should be submitted to HEW in accordance with the forwarding instructions sent to the school system with its report forms. 

Before mailing, remove the school system's file copy from each set of reports. If the school system is instructed to mail the report 

to HEW through its State education agency, mail the four HEW copies and the State education copy to your State education 

agency. If the report is mailed directly to HEW, mail the State education agency copy to your State education agency and the 

four HEW copies to: : 

OFFICE FOR CIVIL RIGHTS 
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 
POST OFFICE BOX 14195 

WASHINGTON, D.C. 20044 

 



= oo FORM OS/CR 101-1 
REPORTING REQUIREMENT: FALL, 1969 ELEMENTARY AND SECONDARY SCHOOL SURVEY BUDGET BUREAU 

  

This report is required pursuant to the Office for Civil Rights NOS 3wR0.103 
: ool Department of Health, Education & Welfare EXPIRATION DATE 

HEW Regulation (45 CFR 80) issued to P.O. Box 14195 8/31/70 

carry out the purposes of Title VI of the 

Civil Rights Act of 1964. Section 

80.6(b) of the Regulation provides: 

Washington, D.C. 20044 
Telephone: 202-338-7866 
Due December 20, 1969 

Compliance Reports. Each recipient shall SCHOOL SYSTEM SUMMARY REPORY 

keep such records and submit to the re- 

sponsible Department official or his de- 

signee timely, complete and accurate 

‘compliance reports .at such times, and in 
such form and containing such informa- 
tion as the responsible Department of- 

ficial or his designee may determine to 

be necessary to enable him to ascertain 

whether the recipient has complied or is 

complying with this Regulation.     
  

  

  
    

  

  

  

  

I Name of School System 

n Street Address 

III. City , County , State , Zip Code 

IV. Name of Chief Administrative Officer of School System 

Vv. Number of Individual School Campus Report Forms Attached: 

VL STUDENT ENROLLMENT IN THIS SYSTEM. Do not use percentages, average daily attendance, average daily membership, or year-end 
enrollment. ; 

Col. 1 Col. 2 Col. 3 Col. 4 Col. § Col. 6 
All Indi- 

FALL, 1969 Spanish viduals NOT School 
: American Surnamed Included in System 

~ Indian Negro Oriental American Cols. 1-4 Totals 

  

Total student enrollment in 

A. this system (sum of 102-1 
forms Item VI.A.) 
  

B Nonresident students enrolled in’ 
* this system 

  

Resident students enrolled in 

this system             
  

VII. RESIDENT STUDENTS NOT ENROLLED IN THIS SCHOOL SYSTEM. 

  

A Resident students enrolied in another | 
* Public School system (estimate) 

  

Resident students enrolled in 
* nonpublic schools (estimate) 

  

Resident school age children not 
in school (estimate)             
  

FULL-TIME PROFESSIONAL STAFF ONLY. Note: Professional includes principals, ass’t principals, classroom teachers and those staff 
members who are supervisors of instruction, curriculum consultants, school librarians, non-classroom teachers (homebound, etc.), audio- 
visual staff, TV teachers, guidance counselors and school psychologists—assigned to this school system ona FULL-TIME BASIS. Do not 
use percentages, fractions, or full-time equivalents. 

VIII. 

  

A. Total FULL-TIME Professional 
Staff assigned to ONE School Campus 

only (sum of Individual School Cam- 

pus Report Forms, item VIILE.) 
  

+B. Total FULL-TIME Professional 
. Staff assigned to more than one 

School Campus 
  

C. Total of A.-and B. above. 

  

IX. Total FULL-TIME Classroom Teach- 
ers assigned to ONE School Campus 
only (sum of Individual School Cam- 

pus Report Forms Item VIII. A.) 

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OPTIONAL ITEM: PART-TIME PROFESSIONAL STAFF. » 

  

Persons working less than full- 
time in this school system.               

To assure the submission of correct Title VI compliance data, check the completeness and accuracy of each item reported. Errors 
& omissions may require a refiling of this form. Be sure there is an Individual School Report for each school campus reported in 
tem V. : 

Certification: I certify that the information given with this report is true and accurate to the best of my knowledge and belief. A 
willfully false statement is punishable by law. (U.S.Code, Title 18, Section 1001). 

  
  

  

Signature of Person Furnishing Information (Area Code) Telephone Number Date Signed 

  

Title Fall, 1969 

a 

DUPLICATE-RETURN TO OFFICE FOR CIVIL RIGHTS (RESEARCH) 

731d 

 



  

: : INSTRUCTIONS FOR FORM OS/CR 102-1 
U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

Office for Civil Rights 
Washington, D.C. 

INDIVIDUAL SCHOOL CAMPUS REPORT 
FALL 1969 ELEMENTARY AND SECONDARY SCHOOL SURVEY 

Due December 20, 1969 

General Instructions: The Fall, 1969 Elementary and Secondary School Survey consists of two report forms: Forms OS ‘CR 101-1, 

School System Summary Report; and OS/CR 102-1, Individual School Campus Report. The data reported should reflect the facts 

when enrollments and professional staff assignments can be considered stabilized, normally in the latter part of September. 

This report is due December 20, 1969. 

ITEM L A. Use the school system name your State uses in its published official listing of its school districts. 

B. The OCR School System Number consists of the first 10 digits of the number at the top of the label 
affixed to Form OS/CR 101-1 sent the school superintendent. If this form is completed at individual 

school campuses, the superintendent should transmit the OCR school system number to each school. 

ITEM IL. State the name of the school campus covered by this report. If a school has classroom facilities in more than one 
geographical location, an Individual School Campus Report Form 102-1 must be filed for each separate location. 

ITEM III. Give the street address of the school campus covered by this report. 

ITEM IV. Complete the address. Do NOT forget to give the zip code. 

ITEM V. Put an “x” in every box which indicates a grade offered at this school campus. 

ITEM VI. A. Please edit stabilized Fall, 1969 student enrollment data. Enter the number of students in each ethnic 
category. Ethnic categories are considered mutually exclusive; count an individual in one ethnic category only. If 
there are no persons in an ethnic category, enter “0” for the category. Do NOT use percentages, average daily 
attendance, average daily membership, or year-end enrollment. 

Categories: 

Col. 1: American Indian. Persons considered by themselves, by the school, or by the community to be of 
American Indian origin. 

Col. 2: Negro. Persons considered by themselves, by the school, or by the community to be of African or 
Negroid origin. 

Col. 3: Oriental. Persons considered by themselves, by the school, or by the community to be of Chinese, 
Japanese, or other Oriental origin. 

Col. 4: Spanish Surnamed American. Persons considered by themselves, by the school, or by the com- 
munity to be of Mexican, Puerto Rican, Central-American, Cuban, Latin-American, or other 
Spanish speaking origin. 

Col. 5: Enter all individuals NOT included in one of the four ethnic categories (Col. 1-4). 

‘ Col. 6: Totals. Add together all individuals entered in Cols. 1-5. 

ITEM VIL OPTIONAL ITEM: PART-TIME Professional Staff members working less than full-time at this school campus. 

Do NOT report these individuals in Item VIII. below. 

ITEM VIII. FULL-TIME Professional Staff Assigned to this Sc hoo! Campus on a Full- time Basis: Please enter in the ap- 
ropriate line and column the number of full-time professional staff members assigned to this school campus on 

a FULL-TIME basis. These are professional staff whose current ssignments require their services at this 
school campus for the whole school day, every day. If there are no full-time professional staff members in an 
ethnic category, enter * ‘0” for the category. 

   

LINE A. Classroom Teachers: Enter in the appropriate line and column the number of FULL-TIME class- 
room teachers. These are the professional staff members who instruct students in courses in 
classroom situations. Enter each classroom teacher at the grade level which represents this teacher's 
major assignment. If a teacher has sole responsibility for two grade >s, enter the teacher in onc grade 
only. Enter “0” in the other grade. Do NOT enter the teacher ¥ in one grade and %2 in another. If 
the principal teaches at all, enter the principal as a teacher and not as a principal. The same applies 
to teaching assistant principals, if grades 7 and 8 are considered secondary grades at this school, 
report the 7th and 8th grade t cachers as secondary classroom teachers. 

Secondary Classroom Teachers: Enter in the appropriate cthnic category the FULL-TIME 
secondary classroom teachers. 

Ungraded Special Education Classroom Teachers. Enter in the appropriate ethnic category the 
number of FULL-TIME classroom teachers teaching ungraded special education courses. 

Other Elementary Classroom Teachers: Enter in the appropriate ethnic category the other 
FULL-TIME elementary classroom teachers such as art, music, band, physical education, home 
economic, etc. who have NOT been included in the above grade levels. 

Total Classroom Teachers: Enter the sum of the classroom teachers for each of the six columns. 
These totals MUST include every FULL-TIME classroom teacher working at this school campus. 

LINE B. Other FULL-TIME Professional Staff: Enter in the appropriate ethnic category the number of 
professional staff members who are supervisors of instruction, curriculum consultants, school 
librarians, non-classroom teachers (homebound, etc.), audio-visual staff, T.V. teachers, guidance 
counselors, and school psychologists assigned to this school campus on a full-time basis. Do NOT 
include: Staff members who work at this school campus on a part-time basis; para-professional 
staff members, such as teacher's aides and student teachers; and non-instructional staff members 
such as business, financial, professional health personnel (doctors and nurses), school social 
workers, transportation, clerical, custodial, and food service, and attendance personnel. 

LINE C. The Principal: Enter in the appropriate ethnic category the FULL -TIME principal of this school 
campus. If the principal teaches, or is principal of more than one school campus, enter “0” on this 
line. Count teaching principals only as teachers in the appropriate grade and category (Item VIil. 
A.) above. 

LINE D. Assistant Principals: Same as Item VIII. C. above. 
LINE E. Enter the sum of VIII. A, B, C, and D for each of the six columns. p 

LINE F(1). Enter in the appropriate ethnic category the number of vacancies filled at this school campus by 
full-time professional staff members new to this school system between 10/1/68 and 10/1/69. ) 

LINE F(2). Enter in the appropriate ethnic category the number of vacancies filled in the full-time professional 
staff of this school campus between 10/1/68 and 10/1/69 by the transfers from other 
school campuses of this system. 

LINE G. Enter the number of unfilled full-time professional staff positions at this school campus as of the 
date this form is completed. 

ITEM IX. For the purpose of this question, additions do NOT include: (A) temporary structures, such as mobile class- 
rooms, or (B) structures which do not accommodate increased student capacity of this school campus, such as 
cafeteria, gymnasium, or school library. 

SUBMISSION OF REPORT: It is the responsibility of each school system to submit this report by December 20, 1969. If the 
report is completed at the individual school campuses, it should be returned to the superintendent s office for forwarding to HEW. 
Before submitting the report, check the accuracy and completeness of each item, particularly the totals. Errors or omissions may 
require a refilling of the form. 

 



  

  

  

  

  

  
      

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

. FORM 

Office for Civil Rights FALL 1969 ELEMENTARY AND SECONDARY SCHOOL SURVEY ( : "CR 102-1 

Department of Health, Required Under Title VI of the Civil Rights Act ot 1964 BUDGET BUREAU 
Education & Weltare Duc December 20, 1969 ’ ed Jost yh No. 
Box 14195 t J SELNr . ni : TF i Ey. «110 

. » Washington, D.C. 20044 INDIVIDUAL SCHOOL CAMPUS REPORT-FALL, 1969 EXPIRATION DATE: 

Telephone: 202-338-7866 
8/31/70 

I. A. Name of School System 

B. OCR School System Number 

HH Name of School Campus 

Il. Strect Address 

IV. City , County , State , Zip Code 

N Grades offered (Put an “x” in the appropriate box for every grade offered at this school) 

Pre-K K 1 2 3 4 5 6 7 8 9 10 11 12 Ungraded 
0 0 a 0 QO 0 @ a O a a 0 1 [8] O 

VI. STUDENTS: Report in the appropriate ethnic category the number of enrolled students. Do not use percentages, average daily attend- 

ance, average daily membership, or year-end enroliments. 

Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6 
All Indi- 

FALL, 1969 Spanish viduals NOT 
American Surnamed Included in 
Indian Negro Oriental American Cols. 1-4 Totals 

A. Enrolled Students— Pre-K 

K 

1 

2 

3 

4 

S 5 
: 6 
U 

D 7 

E 8 
N 
T 9 

S 10 

11 

12 

Ungraded Special Educa. 

Other Ungraded 

TOTAL Student Enrollment       
  

VIL. OPTIONAL ITEM: PART-TIME PROFESSIONAL STAFF 

Person working LESS THAN 
$4.3 } S| MN BS 1 TIAL og ~ F—— o FULL-TIME at this school campus. { 

  

1 | 
  

VIII FULL-TIME PROFESSIONAL STAFF. Do NOT use percentages, fractions, or full-time equivalents. 
  

A. Classroom Teachers, Pre-K | 
including teaching 
Principals and teach- K 
ing Assistant Principals, 
assigned to this school 1 
campus on a FULL- 
TIME basis ONLY. 

  

  

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= 
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m
 

  

(S
S ]

 

  

  Elementary Classroom 

Teachers (by grade) 
  

2
 

  

  

  

+ 
E
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JE
 

TR
E 

T
S
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T
R
 

1 

  

Other Elementary Classroom 
Teachers: (Art, Music, Band, 

Phys., Ed., Home Ec., etc. 

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~
2
0
 

  

Secondary Classroom Teachers 

(as a group) 
  

Ungraded Special Education 
Classroom Teachers 
    » TOTAL Classroom Teachers 

  

  

B. Other FULL-TIME Professional Staff 

C. The Principal (Non-Teaching) 

D. Assistant Principals (Non-Teaching) 

E. TOTAL of A,B,C,D 

F. Vacancies filled in Full-Time Profes- 
sional Staff of this School Campus 
between 10/1/68 and 10/1/69 

(1) Newly hired staff members 

(new to this system) 

  

  

  

  

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=
0
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A
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(2) Transfers (staff members trans- 
ferred from another school campus 
of this system) 

(3) TOTAL of (1) and (2) 
              m

p
 = 

  

G. Number of Current Vacancies in Full-time professional staff. 3 H. Item VI and VIII furnished as of (date) 

  

IX. Has there been any permanent building construction which would accommodate increased student capacity at this school campus 

between 10/1/08 and 10/1/69% Yes... No. 

Certification: I certify that the information given with this report is true and accurate to the best of my knowledge and belief. A will- 

fully false statement is punishable by law. (U.5. Code, Title 18, Section 1001). 

  
    

Signature of Person Furnishing Information Title (Arca Code) Telephone Number Date Signed 

ORIGINAL—-RETURN TO OFFICE FOR CIVIL RIGHTS (LEGAL) 

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