**LEA Name**  **National Center for Education Statistics**  **(NCES) District Identification Number**  **SY 2009-2010 Aggregate**  **Expenditures SY 2010-2011** 

**Aggregate Expenditures** * **SY 2011-2012**

**Aggregate Expenditures**  **Difference**

**2011-2012 vs. SY 2010-**  **2011 Percentage**  **2011-2012 vs. SY 2010-2011**  **SY 2009-2010 Per-pupil**  **Expenditures  ** SY 2010-2011** **Per-pupil Expenditures** ** **SY 2011-2012 Per-pupil**  **Expenditures******Difference**

**2011-2012 vs. SY 2010-**  **2011 Percentage**  **2011-2012 vs. SY 2010-2011** **Percentage Reduction of**

**Covered Program if MOE Waiver Request Denied**  Sample LEA 9999999 $1,000,000 $1,100,000 $950,000 -$150,000 -13.64% $8,000 $8,050 $6,800-$1,250.00 -15.53% -4.04% $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0! $0 #DIV/0! $0.00 #DIV/0! #DIV/0!

**If an LEA calculates MOE using more than one per-pupil measure (i.e., enrollment, membership, or attendance), provide the data for the per-pupil measure on which the LEA came closest to maintaining effort.) 

### Form 1: Local Educational A **gency (LEA**

**) Expenditure Data** *The comparison year expenditures (SY 2010-2011) are equal to actual SY 2010-2011 expenditures unless the LEA failed to maintain effort in SY 2010-2011. For an LEA that did not maintain effort in SY 2010-2011, report 90 percent of the SY 2009-2010 figure in the SY 2010-2011 column in accordance with section 9521(b)(2) of ESEA. OMB Number: 1810-0693 Paperwork Burden Statement According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1810-0693. The time required to complete this information collection is estimated to average 8 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4536. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Todd Stephenson, Office of Elementary and Secondary Education, U.S. Department of Education, 400 Maryland Avenue, S.W., 3C118, Washington, D.C. 20202.**LEA Name National Center for**  **Education Statistics (NCES) District**  **Identification Number Local SY**  **2009-2010 Revenue**  **State SY**

**2009-2010 Revenue**  **SY 2009-2010**

**Non-revenue Receipts**  **SY 2009-**

**2010 Total Local SY** 

**2010-2011 Revenue**  **State SY**

**2010-2011 Revenue**  **SY 2010-2011**

**Non-revenue Receipts**  **SY 2010-**

**2011 Total Local SY** 

**2011-2012 Revenue**  **State SY**

**2011-2012 Revenue**  **SY 2011-2012**

**Non-revenue Receipts**  **SY 2011-2012**

**Total $ Difference**  **SY 2011-2012 vs. SY 2010-**  **2011 %** **Difference SY 2011-2012**  **vs. SY 2010- 2011**  Sample LEA9999999 $500,000 $500,100 $5,000 $1,005,100 $550,000 $600,000 $5,600$1,155,600 $420,000 $530,000 $0 $950,000.00 -$205,600.00 -17.79% **Form 2: Local Educational A gency (LEA** 

**) Revenue Data**

### LEA

**Name National Center for** 

**Education Statistics (NCES) District**  **Identification Number Explanation of why LEA**  **did not maintain effort***

Sample LEA 9999998

### Form 3: Explanation

*Section 9521(c) of the ESEA gives the Secretary the authority to waive the ESEA's MOE requirement for an LEA if it would be equitable to grant the waiver due to an exceptional or uncontrollable circumstance such as a natural disaster or a precipitous decline in the LEA's financial resources.