COMMONWEALTH of PENNSYLVANIA2016-17 Title I Application

COMMONWEALTH OF PENNSYLVANIA2016-17 Title I Application

DEPARTMENT OF EDUCATION

Nonpublic School Involvement Verification Form

A. Local Educational Agency (LEA)
Superintendent Name and Mailing Address: / Title I Coordinator and Telephone Number:
B. Nonpublic School Information (Only one form is needed for each Diocese.)
Name and Mailing Address: / Contact Person and Telephone Number:
C. Nonpublic Agency Involvement (to be completed by Diocesan Superintendent or the Superintendent's designee on behalf of Roman Catholic schools and contact person for non-Catholic schools)
Note: A "YES" response indicates that nonpublic schools are in agreement with the planned Title 1 Part A program, including the funds allocated for the nonpublic school services.
YES
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


 / NO
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
 / 1.
2.
3.
4.
5.
6.
7. / Were you involved in planning the Title I program?
Did the planning include the identification of economically disadvantaged children?
Did the planning include the identification of educationally disadvantaged children using multiple, educationally related criteria?
Did the planning include an assessment of the special needs of the educationally disadvantaged children?
Did the planning include suggestions on how to coordinate this program with the regular program?
Did the planning include suggestions to evaluate the services based upon student improvement?
Did you review the Title IA Selection of Schools and Reservation of Funds in eGrants?

LEANonpublic Institution

Signature:Signature:

Title:Title:

Date:Date:

COMMONWEALTH OF PENNSYLVANIA2016-17 Title I Application

DEPARTMENT OF EDUCATION

Note: Do notSubmit copies of letters sent to (or received from) nonpublic schools choosing not to participate(letters should be retained at the school district for verification).

General Instructions

Section 9501 of No Child Left Behind requires equitable participation opportunities for nonpublic schools in the Title I Program. NCLB requires prior consultation with nonpublics to determine the services to be provided through grant funds. Such consultation must occur prior to making any decisions that may impact the opportunity for students, parents and staff of nonpublic schools to participate in the program.

Information regarding nonpublic school students should be uploaded to eGrants prior to the submission of the 2016-17Title I Application to PDE. An LEA is required to survey nonpublic schools where low-income students attend to determine the number of nonpublic schools choosing to participate in the 2016-17Title I program.

Nonpublic schools may request Title I services for students, teachers and/or parents that meet the intent of the Title I program. The LEA must plan and coordinate these services with nonpublic school representatives.

This verification form should be sent to the Diocese or nonpublic school (for non-Catholic schools) for signatures after services have been determined.

Section A

Enter the name and mailing address of the LEA. Include the name and telephone number of the contact person.

Section B

Enter the name and mailing address of the nonpublic school. Include the name and telephone number of the contact person at the nonpublic school. Note: Only one form needs to be submitted for each Diocese. LEA contacts should be made with the Diocesan Superintendent or the Superintendent’s designee.

Section C

This section should be completed by the diocesan or nonpublic school representative aftertimely and meaningful planning consultation has taken place.

After sections A-C are completed, upload form on the eGrants system.

Revised October 20181