To: RIC Director/Big 5 Data Coordinator Fax Number: 518-862-5305

This form must be completed and submitted to your RIC Director/Big 5 Data Coordinator October 8, 2010.

To: RIC Director/Big 5 Data CoordinatorFax Number: 518-862-5305

From:Number of Pages:

Date:

District/Charter School/Article 81 School Name:

District/Charter School/Article 81 School 12-Digit BEDS Code:

2009–10Statement of Certification of Verification Report(s)

I have reviewed the verification report(s)indicated below, which were generated using nySTART on the date(s) indicated in the table belowfor my entity (district/charter school/Article 81 school).I understand that the report(s) were generated from data on Level 2 of the Student Information Repository System. I also understand that data in Level 2 of the repository will be frozen as of October 1, 2010 and the data in the repository as of this date will be used for accountability determinations and to populate the New York State Report Cards. The final reporting deadline is dependent on the results of the State Education Department’s request for a waiver to reporting elementary/middle-level school accountability statuses before the beginning of the 2010–11 school year. For more information about the waiver, see

Directions:Check the box for the appropriate certification statement for each verification report being certified and write the date on which the report being certified was generated from nySTART in the “Date Generated” column. Fax this completed, signed, and dated form to your RIC or Big 5 City School District data coordinator.

Verification Report / Date Generated
(Month/Day) / I certify the accuracy of the data in this report for my entity. / I cannot certify my data, but I understand that the deadline for making corrections has passed and that my Level 1 Repository operator will move my data to Level 2.
Elementary/Middle-Level Accountability (AVR) /  / 
High School Accountability /  / 
New YorkState Alternate Assessment /  / 
Elementary/Middle-Level Science /  / 
Elementary/Middle-Level Social Studies /  / 
AnnualHigh School /  / 
Other AnnualHigh School /  / 
Total Cohort /  / 
Reading First /  / 

Name of Certifying Official (Please print.)

Signature of Certifying Official

Date of Certification

Title of Certifying Official:

Superintendent

CharterSchool Principal

Other Chief School Officer

Important Notice: Please keep copies of the certified 2009–10 verification reports

on file,as these reports can only be accessed for a limited time using nySTART.