Spreadsheet: 00a6295f-2f67-4ae5-85f1-7f33bf7dce61
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Revised 09/02/10 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | School District IRN
Center for School Options and Finance
Office of Finance Program Services
Tuition Certification and Report of CHILDREN WITH DISABILITIES
In Membership Pursuant to Section 3323.13 & 3323.14 O.R.C.
SF-14H Form
Be sure to read the eligibility requirements & certification sections in the instructions prior to completing this form!!!
School District: |  |  |  |  |  |  |  |  |  |  |  |  |  |  | County:
School Year: |  |  | 20 |  |  | - | 20 |  |  | Reporting Period: |  |  |  | First (Jul 1 - Dec 31) |  |  |  | Second (Jan 1 - Jun 30)
Section I - District Responsible for Tuition
Dist Responsible for Tuition:
County: |  |  |  |  |  |  |  | Superintendent:
Address:
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | School District IRN
Section II - Certification
1 |  | Did you or a delegate invite the parent's district of residence to attend the individualized education program meeting or the multi-
 |  | factored evaluation meeting for the child? |  |  |  |  |  |  |  |  |  |  |  | YES |  |  | NO
2 |  | Did you or a delegate of your district receive a copy of the individualized education program or multi-factored evaluation for the
 |  | child from the parent's district of residence? |  |  |  |  |  |  |  |  |  |  |  | YES |  |  | NO
3 |  | Did you or a delegate of your district inform the parent's district of residence in writing that the child was being provided
 |  | educational programs by the educating district? |  |  |  |  |  |  |  |  |  |  |  | YES |  |  | NO
We certify we have read, understand, and complied with the instructions.
City, Exempted Village, Local Superintendent Signature |  |  |  |  |  |  |  |  |  | Date |  | [NAME]'s Signature |  |  |  |  |  |  |  |  | Date
Contact Person/Telephone Number/E-mail Address
Section III - Pupil Information
A |  |  |  |  | B |  | C | D | E | F |  |  |  |  | G | H |  | I |  | J
Pupil's SSID Number |  |  |  |  | Entry Date | WD Date | ORC Code | Cat of Hand | EMIS Status Code | Address |  |  |  |  | Date of Birth | Grade Level |  | No of Days |  | Rev Days
Return original and 1 copy of this form and 2 copies of any legal |  |  |  |  |  |  |  |  |  |  |  |  | FOR DEPARTMENT USE ONLY
documents related to the SSID number of pupils listed in Column A |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Rec'd from Educating District
to the Area Coordinators on or before March 1 or August 1 for |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Letter to Responsible District
the respective reporting period. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Entered into Computer
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Correction Entered
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | PAGE
Tuition Certification and Report of CHILDREN WITH DISABILITIES
In Membership Pursuant to Section 3323.13 & 3323.14 O.R.C.
SF-14H Attachment Form
Be sure to read the eligibility requirements & certification sections in the instructions prior to completing this form!!!
School District: |  |  |  |  |  |  |  |  |  |  |  | County: |  |  |  | IRN:
Dist. Responsible for Tuition: |  |  |  |  |  |  |  |  |  |  |  | County: |  |  |  | IRN:
Section III - Pupil Information (continued)
A |  |  |  |  | B |  | C | D | E | F |  |  |  |  | G | H |  | I |  | J
Pupil's SSID Number |  |  |  |  | Entry Date | WD Date | ORC Code | Cat of Hand | EMIS Status Code | Address |  |  |  |  | Date of Birth | Grade Level |  | No of Days |  | Rev Days
Return original and 1 copy of this form and 2 copies of any legal |  |  |  |  |  |  |  |  |  |  |  |  | FOR DEPARTMENT USE ONLY
documents related to the SSID number of pupils listed in Column A |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Rec'd from Educating District
to the Area Coordinators on or before March 1 or August 1 for |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Letter to Responsible District
the respective reporting period. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Entered into Computer
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Correction Entered