EXEMPT, RELIGIOUS & OTHER SCHOOLS ENROLLMENT FORM
In accordance with AS 14.45.030 and AS 14.45.110 (b), all exempt, religious and other schools are required to report enrollment by grade on an annual basis. The enrollment count must be as of October 1, and is due in the office on or before October 15.
Name of School: ______
Mailing Address______City______State_____ Zip Code______
Telephone: ______Fax: ______Email: ______
Number of Alaska Certificated Teachers:______Number of Professional Staff (including Alaska Certificated Teachers): ______
Please indicate with an “X”: PrivateReligiousSchoolorPrivateNon-ReligiousSchool
Enrollment by grade (please indicate number of students in each grade):
*Pre-El / KG / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 /TOTAL
If not enrolled by grade, please indicate number of students in each category. Do not complete if enrollment was entered above.
*Pre-El / KG-8 / 9-12 / TOTALSchool Year ______
Number of High School Graduates from the previous school year: ______
* If your school serves pre-elementary age children, the State of Alaska may require you to license your childcare facility. To find out whether this applies in your case, contact Childcare Licensing at (907) 296-4500.
Are all of the students in your school members of your immediate family?YorN(circle one)
Are you a boarding school?YorN(circle one)Note: Not applicable if answered yes to above question.
If you have a corporal punishment policy on file with the Department of Education & Early Development, was there any revision?
YNNA(Circle one) Note: If “Y” was circled, the revision(s) are to be sent with this packet.
Signature and Title of Person Completing Report: ______Date: ______
Return to:Alaska Department of Education & Early DevelopmentDivision of Teaching and Learning Support
Attn: HeatherKahklen801 West 10th Street, Suite 303, P.O. Box 110500, Juneau, AK 99811-0500
Form # 05-01-022Page 1 of 1
Alaska Department of Education & Early Development