P-12

Data Collection Forms

Title I Schoolwide Program Notification Form

Projected Year of Implementation:
LEA:
School Name:
School BEDS Code:
Grade Span in School:
Enrollment:
Low Income Measure - Check one and include percentage
Free/Reduced Lunch ADFC Census Data Medicaid Composite
%
Principal's Name:
Telephone:
Fax:
E-mail:
Title I Coordinator's Name:
Telephone:
Fax:
E-mail:
Schoolwide Planning Team
Name Title
Please print a copy of the completed form before clicking on the "Submit" button.

If you have any questions, please contact Title I School & Community Services at conappta@mail.nysed.gov or (518) 473-0295.

Last Updated: June 13, 2014