FLORIDA DEPARTMENT OF EDUCATION
?
STATE BOARD OF EDUCATION
?
John L. Winn
Commissioner of Education
F. PHILIP HANDY,
Chairman
T. WILLARD FAIR,
Vice Chairman
Members
DONNA G. CALLAWAY
JULIA L. JOHNSON
ROBERTO MARTÍNEZ
Contact Information:
PHOEBE RAULERSON
Eileen L. Amy or Bill Parker
LINDA K. TAYLOR
850-245-0476
Eileen.Amy@fldoe.org
MEMORANDUM
?
Bill.Parker@fldoe.org
TO:
Exceptional Student Education Directors
K12: 2005-06
FROM:
Bambi J. Lockman
DATE:
February 15, 2005
SUBJECT:
2004-2005 Report of Residential Contract Costs (Form #ESE085)
In support of the Florida Department of Education’s goal to ensure quality and efficient services,
Rule 6A-6.0361(7)(f), Florida Administrative Code (FAC), requires school districts that contract
with a nonpublic residential school or community facility program to provide special education
and related services to a student with disabilities to submit a copy of the contract to the
Department of Education. Please complete the enclosed Report of Residential Contract Costs
(Form ESE 085) for each contract for residential placement, and return the form(s) with a copy
of the contract to Eileen L. Amy, Administrator, ESE Program Administration and Quality
Assurance, by March 31, 2005.
When contracts with nonpublic residential schools are used, please remember the following:
1.
?
Annually, a copy of the contract(s) signed by all participating parties must be filed with the
Bureau of Exceptional Education and Student Services.
2.
?
When a contract with a nonpublic residential school is terminated prior to the anticipated end of
the contract period, the contract termination section of ESE 085 must be completed and
submitted to the Bureau.
Districts are also required to submit to the Bureau, as specified in Rule 6A-6.0361(7)(f), FAC, a
copy of contracts for educational services for students with disabilities served by nonpublic
schools or community agencies in nonresidential programs
.
BAMBI J. LOCKMAN
Chief
Bureau of Exceptional Education and Student Services
325 W. GAINES STREET • SUITE 614 • TALLAHASSEE, FL 32399-0400 • (850) 245-0475 • www.fldoe.org
K12 Memorandum # 2005-
Exceptional Student Education Directors
February 15, 2005
Page 2
This also includes, but is not limited to, contracts with agencies for the provision of special
education and related services to prekindergarten children with disabilities. This
does not
include
interagency agreements, or cooperative agreements related to the placement of school
district staff in community facilities; nor does it include contractual agreements related to services
provided to students (nondisabled and disabled) in juvenile justice facilities.
Should you need assistance, you may contact Eileen Amy, Administrator, Program Administration
and Quality Assurance, or Dr. Bill Parker, Program Specialist, at (850) 245-0476 or by electronic
mail at Eileen.Amy@fldoe.org or Bill.Parker@fldoe.org. Your continued cooperation in
implementing these procedures is appreciated.
BJL/blp
Enclosure
cc: District School Superintendents
District School Finance Officers
_________________________________________________
_________________________________________________
____________________________________
________________________________________________________________________
____________________________________________________________________
__________________________________________
_______________________________________ __________________________________________
_______________________________________ __________________________________________
Please return annually to:
Administrator, Program Administration
and Quality Assurance
Bureau of Exceptional Education and
Student Services
Florida Department of Education
325 West Gaines Street, Room 614
Tallahassee, Florida 32399-0400
(850) 245-0476, SunCom 205-0476
FLORIDA DEPARTMENT OF EDUCATION
STUDENT ACHIEVEMENT AND ARTICULATION
BUREAU OF EXCEPTIONAL EDUCATION AND
STUDENT SERVICES
REPORT OF RESIDENTIAL
CONTRACT COSTS
2004-2005
1. School District:
Date:
2. Contracted school:
3. Address of Contracted School:
_____________________________________________
_____________________________________________
_____________________________________________
4. Name of Student (Last, First, MI):
5. Florida Student Number Identifier:
6. Date of Birth:
7. Primary Exceptionality: ____________________, Other Areas of Eligibility: _______________, _______________
8. School District Cost of Contract With Nonpublic School: $______________________
9. Matrix Cost Factor: (circle one) 254
255
Not Applicable
10. Does Another Agency Participate in the Cost of Placement?
Yes
No
11. If Yes, List Cost to Each Agency and Name of Agency:
Cost: $______________________ Agency:
Cost: $______________________ Agency:
12. Is Any Insurance Paying Part of Contract?
Yes
No
13. If Yes, List Amount Paid and Name of Insurance Company: $ _____________________
14. Certifying Signature:_______________________________________ _________________________
ESE Administrator or Designee
Date Signed
REPORT OF RESIDENTIAL CONTRACT TERMINATION
?
1. Date of Termination:
2. FTE Count(s) Used During the Contract Period:
October
February
3. Reason for Termination:
4. Present Location of Student:
5. Amount of Actual Expenditure by School District: $
Agency
$
Agency
$
ESE 085
Exp. 08/16/04
Florida Department of Education
