Spreadsheet: 0274ebf2-7818-46d6-b723-4c0592ca3d88
Sheet: FILL OUT WORKSHEET - PRINT

 |  | APPROVAL OF A TUITION COST RATE FOR FISCAL YEAR 2014-15
 |  | Legal Name of Agency/Facility (as listed on the DHS license):
 |  | Name of Facility School/Special Education Program: | ED, self-contained
 |  |  | Actual Reported |  | Average | CDE Approved
 |  |  |  |  | Salary
 |  | FORM A:  PROGRAM IDENTIFICATION
 |  | Number of Program Days for the School Year: |  | 176
 |  | Average Number of Students in Program:
 |  | Number of Students per Staff FTE (applied ratio): |  | 3.5
 |  | Maximum Number of Staff:
 |  | Actual Staff [NAME] under the [NAME]:
 |  | Approved Daily per Student Tuition Cost Rate:
 |  | Approved Daily Additional per Student Education Costs not
 |  | Covered by Applicable Revenues:
 |  | FORM B:  SPECIAL EDUCATION COSTS | FTE | $ | $ | FTE | $
 | JOB CLASS CODES | SECTION I:  INSTRUCTIONAL
 |  | SALARIES - Special Education Teachers
 | 202 | Serious Emotional Disability
 | 202 | Specific Learning Disability
 | 202 | Significant Limited Intellectual Capacity
 | 202 | Hearing Impairment
 | 202 | Visual Impairment
 | 202 | Physical Disability
 | 202 | Autism Spectrum Disorders
 | 202 | Traumatic Brain Injury
 | 202 | Speech or Language Impairment
 | 202 | Deaf-Blindness
 | 202 | Multiple Disabilities
 | 202, 0035 | Preschooler with a Disability
 |  | SUBTOTAL
 | 416 | Teaching Assistant, Special Education
 | 402 | Career Assistant/Job Coach
 | 411 | Library/Media Assistant
 | 410 | Educational Interpreters
 |  | TOTAL
 |  | EMPLOYEE BENEFITS
 |  | PURCHASED SERVICES
 | 238 | Speech - Language Pathologists
 |  | TOTAL PURCHASED SERVICES
 |  | INSTRUCTIONAL STAFF TRAVEL
 |  | SUPPLIES AND MATERIALS
 |  | CAPITAL OUTLAY
 |  | TOTAL INSTRUCTION
 | JOB CLASS CODES | SECTION II:  SUPPORT
 |  |  | FTE | $
 |  | SALARIES
 | 233 | Nurses
 | 234 | Occupational Therapists
 | 235 | Physical Therapists
 | 236 | Psychologists
 | 237 | Social Workers
 | 202, 0037 | Specialty Teachers:  Physical Education
 | 202, 0037 | Other Specialty Teachers: Art, Music, Family Consumer, Industrial Arts
 | 107 | Education Coordinator
 | 102 | Special Education Directors
 | 214 | Educational Diagnostician
 |  | SUBTOTAL
 | 506 | General Office/Secretary
 |  | TOTAL
 |  | EMPLOYEE BENEFITS
 |  | PURCHASED SERVICES
 | 233 | Nurses
 | 234 | Occupational Therapists
 | 235 | Physical Therapists
 | 236 | Psychologists
 | 237 | Social Workers
 | 107 | Education Coordinator
 | 102 | Special Education Directors
 | 214 | Educational Diagnostician
 | 215 | Instructional Program Consultant
 | 347 | Staff Developer
 |  | TOTAL PURCHASED SERVICES
 |  | SUPPORT STAFF TRAVEL
 |  | PUPIL TRANSPORTATION
 |  | OTHER (Example: Field trip costs, admission fees, etc.)
 |  | SUPPLIES AND MATERIALS
 |  | CAPITAL OUTLAY
 |  | TOTAL SUPPORT
 |  | GRAND TOTAL SPECIAL EDUCATION COSTS
 |  | FORM C:  ADDITIONAL EDUCATION COSTS
 | 700 | GENERAL ADMINISTRATION
 |  | Salaries *
 |  | Benefits
 |  | Staff Travel
 |  | Legal Fees
 |  | Insurance and Bonding
 |  | Public Relations
 |  | Supplies and Materials
 |  | TOTAL ADMINISTRATION
 | 800 | GENERAL BUSINESS SERVICES
 |  | Salaries *
 |  | Benefits
 |  | Audit
 |  | Data Processing
 |  | Payroll
 |  | Supplies and Materials
 |  | TOTAL BUSINESS SERVICES
 |  | BUILDING OCCUPANCY - EDUCATION AND SUPPORT SERVICES
 |  | (includes applicable portion of business and administration)
 |  | Utilities
 |  | Communication (Telephone and Postage)
 |  | Insurance (Liability and Property)
 | 900 | JANITORIAL SERVICES
 |  | Janitorial Salaries *
 |  | Janitorial Benefits
 |  | Contract Security & Janitorial
 |  | Janitorial and Building Supplies
 |  | Rent/Lease/Depreciation
 |  | Building Repair and Maintenance
 |  | TOTAL OCCUPANCY
 |  | REGULAR EDUCATION
 | 201 | Teachers Salaries
 | 602 | Van Drivers Wages *
 |  | Regular Education Employee Benefits
 |  | Substitute Teachers Wages *
 |  | Regular Education Supplies and Materials
 |  | TOTAL REGULAR EDUCATION
 |  | NON-INSTRUCTIONAL EQUIPMENT (Vehicle/Copy Machine)
 |  | Lease/Depreciation
 |  | Replacement
 |  | Repair and Maintenance
 |  | Special Education Vehicle Modifications
 |  | TOTAL NON-INSTRUCTIONAL EQUIPMENT
 |  | TOTAL ADDITIONAL EDUCATION COSTS
 |  | FORM D:  EDUCATION PROGRAM REVENUES
 |  | OTHER EDUCATION REVENUES
 |  | Cash Donations
 |  | Other Education Grants (Specify)
 |  | TOTAL OTHER EDUCATION PROGRAM REVENUES
 |  | FORM E:  CALCULATION OF A TUITION COST RATE
 |  | 1. Total special education costs (from Form B)
 |  | 2. Additional education costs (from Form C)
 |  | 3. Education program revenues (from Form D)
 |  | 4. Additional education costs above applicable revenues (calculated)
 |  | 5. Total education costs above applicable revenues (calculated)
 |  | 6. Percent of total education costs for special education (calculated)
 |  | 7. 2014-15 estimated state average PPR |  | 7020.58
 |  | 8. PPR to be applied as a revenue for special education (calculated)
 |  | 9. Average number of students in program (from Form A)
 |  | 10. Per student special education costs above revenues,
 |  | excluding PPR (calculated)
 |  | 11. Approved tuition cost per student (calculated)
 |  | 12. Number of program days for the school year (from Form A)
 |  | 13. Daily per student tuition cost rate (calculated)
 |  | 14. Per student education cost above applicable revenues
 |  | (calculated)
 |  | 15. Per student education costs above PPR and tuition cost
 |  | (calculated)
 |  | 16. Daily per student additional education costs not covered by
 |  | applicable revenues (calculated)