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FORM SF-PS-140B | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | RETURN TO: | Unnamed: 13 | Unnamed: 14 | Unnamed: 15
REV. 3/01 |  |  |  |  |  |  |  |  |  |  |  | ODE-AREA OFFICE
 |  |  |  | OHIO DEPARTMENT OF EDUCATION |  |  |  |  |  |  |  | ATTN:
 |  |  |  | DIVISION OF SCHOOL FINANCE
 |  |  |  | POST-SECONDARY INSTITUTION REIMBURSEMENT FORM
The purpose of this form is to collect the total cost of participating public and nonpublic pupils attending post-secondary institutions pursuant
to AM. SB. 140, Section 3365.07; 3365.08 ORC.
 |  |  |  |  |  |  |  |  |  |  |  | SCHOOL YEAR ____ - ____
I. | I. POST-SECONDARY INSTITUTION INFORMATION
 |  | A. | NAME OF POST-SECONDARY INSTITUTION |  |  |  |  |  | C. | POST-SECONDARY INSTITUTION ADDRESS
 |  | B. | INFORMATION RETRIEVAL NUMBER  (IRN) |  |  |  |  |  | D. | CONTACT PERSON |  | TELEPHONE NUMBER
 |  |  |  |  |  |  |  |  | E. | E-MAIL ADDRESS
II. | STUDENT INFORMATION
(A) |  |  |  |  | (B) |  |  | (C) |  |  |  | (D) |  |  | TOTAL
NAME |  |  |  |  | SCHOOL DISTRICT             IF AN 0-8 PLEASE LIST CITY WHERE LOCATED |  |  | HIGH SCHOOL |  |  | TUITION | COST OF TEXTBOOKS & SUPPLIES | TOTAL COST |  | # OF CREDITS FOR YR
1. |  |  |  |  |  |  |  |  |  |  |  |  | 0
2. |  |  |  |  |  |  |  |  |  |  |  |  | 0
3. |  |  |  |  |  |  |  |  |  |  |  |  | 0
4. |  |  |  |  |  |  |  |  |  |  |  |  | 0
5. |  |  |  |  |  |  |  |  |  |  |  |  | 0
6. |  |  |  |  |  |  |  |  |  |  |  |  | 0
7. |  |  |  |  |  |  |  |  |  |  |  |  | 0
8. |  |  |  |  |  |  |  |  |  |  |  |  | 0
9. |  |  |  |  |  |  |  |  |  |  |  |  | 0
10. |  |  |  |  |  |  |  |  |  |  |  |  | 0
11. |  |  |  |  |  |  |  |  |  |  |  |  | 0
12. |  |  |  |  |  |  |  |  |  |  |  |  | 0
13. |  |  |  |  |  |  |  |  |  |  |  |  | 0
14. |  |  |  |  |  |  |  |  |  |  |  |  | 0
15. |  |  |  |  |  |  |  |  |  |  |  |  | 0
16. |  |  |  |  |  |  |  |  |  |  |  |  | 0
17. |  |  |  |  |  |  |  |  |  |  |  |  | 0
18. |  |  |  |  |  |  |  |  |  |  |  |  | 0
19. |  |  |  |  |  |  |  |  |  |  |  |  | 0
20. |  |  |  |  |  |  |  |  |  |  |  |  | 0
PLEASE MAKE SURE TO LIST STUDENTS BY SCHOOL DISTRICT AND THEN ALPHABETICAL ORDER.
BY GROUPING ALL OF THE STUDENTS TOGETHER BY HIGH SCHOOL, WE WILL BE ABLE TO CUT DOWN
ON DUPLICATION.
ODE.SOF.FPS.form.SF-PS-140B.09/2007
FORM SF-PS-140B
REV. 3/01
A. | NAME OF POST-SECONDARY INSTITUTION |  |  |  |  |  | B. | INFORMATION RETRIEVAL NUMBER  (IRN) |  |  |  | Page | of
(A) |  |  |  |  | (B) |  |  | (C) |  |  |  | (D) |  |  | TOTAL
NAME |  |  |  |  | SCHOOL DISTRICT |  |  | HIGH SCHOOL |  |  | TUITION | COST OF TEXTBOOKS & SUPPLIES | TOTAL COST |  | # OF CREDITS FOR YR
21. |  |  |  |  |  |  |  |  |  |  |  |  | 0
22. |  |  |  |  |  |  |  |  |  |  |  |  | 0
23. |  |  |  |  |  |  |  |  |  |  |  |  | 0
24. |  |  |  |  |  |  |  |  |  |  |  |  | 0
25. |  |  |  |  |  |  |  |  |  |  |  |  | 0
26. |  |  |  |  |  |  |  |  |  |  |  |  | 0
27. |  |  |  |  |  |  |  |  |  |  |  |  | 0
28. |  |  |  |  |  |  |  |  |  |  |  |  | 0
29. |  |  |  |  |  |  |  |  |  |  |  |  | 0
30. |  |  |  |  |  |  |  |  |  |  |  |  | 0
31. |  |  |  |  |  |  |  |  |  |  |  |  | 0
32. |  |  |  |  |  |  |  |  |  |  |  |  | 0
33. |  |  |  |  |  |  |  |  |  |  |  |  | 0
34. |  |  |  |  |  |  |  |  |  |  |  |  | 0
35. |  |  |  |  |  |  |  |  |  |  |  |  | 0
36. |  |  |  |  |  |  |  |  |  |  |  |  | 0
37. |  |  |  |  |  |  |  |  |  |  |  |  | 0
38. |  |  |  |  |  |  |  |  |  |  |  |  | 0
39. |  |  |  |  |  |  |  |  |  |  |  |  | 0
40. |  |  |  |  |  |  |  |  |  |  |  |  | 0
41. |  |  |  |  |  |  |  |  |  |  |  |  | 0
42. |  |  |  |  |  |  |  |  |  |  |  |  | 0
43. |  |  |  |  |  |  |  |  |  |  |  |  | 0
44. |  |  |  |  |  |  |  |  |  |  |  |  | 0
45. |  |  |  |  |  |  |  |  |  |  |  |  | 0
46. |  |  |  |  |  |  |  |  |  |  |  |  | 0
47. |  |  |  |  |  |  |  |  |  |  |  |  | 0
48. |  |  |  |  |  |  |  |  |  |  |  |  | 0
49. |  |  |  |  |  |  |  |  |  |  |  |  | 0
50. |  |  |  |  |  |  |  |  |  |  |  |  | 0
51. |  |  |  |  |  |  |  |  |  |  |  |  | 0
52. |  |  |  |  |  |  |  |  |  |  |  |  | 0
PLEASE MAKE SURE TO LIST STUDENTS BY SCHOOL DISTRICT AND THEN ALPHABETICAL ORDER.
BY GROUPING ALL OF THE STUDENTS TOGETHER BY HIGH SCHOOL, WE WILL BE ABLE TO CUT DOWN
ON DUPLICATION.
ODE.SOF.FPS.form.SF-PS-140B.09/2007