Spreadsheet: 0620635e-b1aa-449c-a703-d635df42f29a
Sheet: SF-6 Form Specific Student

 |  |  |  |  |  |  |  |  |  |  | Office of School Finance
 |  |  |  |  |  |  |  |  |  |  | SF-6
 |  |  |  |  |  |  |  |  |  |  | School Age Form
 |  |  |  |  |  |  |  |  |  |  | for Specific Student Calculation
 |  |  |  |  |  |  |  |  |  |  | Report To Certify the Excess Cost For School District School-Age Pupils
 |  |  |  |  |  |  |  |  |  |  | Who Were Provided Special Education and Related Services
 |  |  |  |  |  |  |  |  |  |  | To be filed by educating district (3323.14 [NAME]) for school year 2012-2013
 |  | Please make selections and type data only in those cells highlighted in blue.
 |  | [NAME]
 |  |  | A. | Educating District - City, Exempted Village or Local
 |  |  |  |  | Please select a district.
 |  |  | B. | Resident District - City, Exempted Village or Local
 |  |  |  |  | Please select a district.
 |  |  | C. | Student disability condition
 |  |  |  |  | Please select a disability condition.
 |  |  | D. | Method of placement (EMIS status code).
 |  |  |  |  | Please select a placement explanation.
 |  |  | E. | Percent of time in regular classroom (0 to 100)
 |  |  |  |  | 0 |  | %
 |  | Section II. Salaries, Benefits, and General Student Costs (General Fund) |  |  |  |  |  |  |  |  |  |  | Actual Costs | Served student FTE by Disability | FTE Percent | Cost per FTE (Column N/ Column O)*Column P
 |  |  | 1. | Special Education Salaries and Benefits
 |  |  | A. | Specific teacher(s) salary
 |  |  |  | Specific teacher(s) benefits
 |  |  | 2. | Instructional Salaries and Benefits by districts |  |  |  |  |  |  |  |  |  | EFM ADM
 |  |  |  | Teacher salaries and benefits by district (functions 11xx, objects 11x, 12x, 131, 21x, 24x, 261))
 |  | Section III.  General Student Costs (General Fund) |  |  |  |  |  |  |  |  |  |  | Reported Costs | EFM ADM |  | Cost per FTE (Column N/ Column O)
 |  |  | 3. Instructional Supplies and Materials By District
 |  |  | Instructional Supplies and Materials (Func 1XXX - Obj 5XX)
 |  |  | 4. Instructional Equipment
 |  |  | Instructional Equipment (Func 1XXX - Obj 6XX, [NAME])
 |  |  | 5. Administration Costs - By District from EFM Report
 |  |  | 6. Operations Support Costs - By District from EFM Report
 |  |  | 7. Staff Support Costs - By District from EFM Report
 |  |  | 8. Pupil Support Costs - By District from EFM Report
 |  | Section IV.  Specific Student Costs and Related Services (General Fund). Completing these fields will replace some items automatically calculated above. |  |  |  |  |  |  |  |  |  |  | Actual Costs | Served student FTE by Disability |  | Cost per FTE (Column N/ Column O)
 |  |  | 9. Provide itemized costs directly tied to a specific student(s).
 |  |  | A. | Contract services (include this item instead of Lines 3,4, 6, 7, and 8 above)
 |  |  | B. | Supplies for specific students
 |  |  | C. | Equipment for specific students
 |  |  | D. | Special transportation cost required by IEP
 |  |  | E. | Aide
 |  |  | F. | Related services (complete worksheet)
 |  | [NAME]
 |  |  | 10. | Total Salaries and Benefits (Section II)
 |  |  | 11. | Total General Student Costs (Section III)
 |  |  | 12. | Total Specific Students Costs (Section IV)
 |  |  | 14. | Total Costs
 |  |  | City, Exempted Village or Local Superintendent Signature |  |  |  |  |  |  |  |  |  | Treasurer Signature