Please return by December 6, 2002, to:
    Title I/Migrant Programs
    Florida Department of Education
    325 West Gaines Street, Room 352
    Tallahassee, Florida 32399-0400
    (850) 487-3530, SunCom 277-3530
    FLORIDA DEPARTMENT OF EDUCATION
    DIVISION OF PUBLIC SCHOOLS AND COMMUNITY EDUCATION
    ANNUAL SURVEY OF CHILDREN IN LOCAL INSTITUTIONS
    FOR NEGLECTED OR DELINQUENT CHILDREN OR
    IN CORRECTIONAL INSTITUTIONS, TITLE I
    (Please read the instructions on reverse before completing this form.)
    FISCAL YEAR
    2002-03
    SECTION I - INSTITUTION AND SCHOOL DISTRICT
    1. NAME AND ADDRESS OF INSTITUTION
    (Include Zip Code)
    3. NAME OF PUBLIC SCHOOL DISTRICT IN WHICH CHILDREN
    RESIDING IN THIS INSTITUTION ATTEND SCHOOL
    2. TYPE OF INSTITUTION
    (Mark only one box to identify the
    type of institution being reported.)
    A.
    ?
    "AN INSTITUTION FOR NEGLECTED CHILDREN" - A
    PUBLIC OR PRIVATE RESIDENTIAL FACILITY
    (Other
    than a foster home)
    THAT IS OPERATED FOR THE CARE
    OF CHILDREN WHO HAVE BEEN COMMITTED TO
    OR VOLUNTARILY PLACED IN THE INSTITUTION
    UNDER APPLICABLE STATE LAW, DUE TO
    ABANDONMENT, NEGLECT, OR DEATH OF
    PARENTS OR GUARDIANS.
    4. LEGAL OR ADMINISTRATIVE BASIS FOR DESIGNATION OF
    THIS INSTITUTION, AS INDICATED IN ITEM 2
    .
    (Please mark
    appropriate box.)
    ?
    A PRIVATE INSTITUTION ADMINISTERED THROUGH A
    CONTRACT WITH THE FLORIDA DEPARTMENT OF JUVENILE
    JUSTICE
    ?
    A PUBLIC INSTITUTION OPERATED BY THE STATE OF
    FLORIDA
    ?
    A PUBLIC INSTITUTION OPERATED BY THE BOARD OF
    COUNTY COMMISSIONERS FOR THE COUNTY IN WHICH THE
    INSTITUTION IS LOCATED
    ?
    OTHER (Explain) ________________________________________
    B.
    ?
    "AN INSTITUTION FOR DELINQUENT CHILDREN" - A
    PUBLIC OR PRIVATE RESIDENTIAL FACILITY THAT
    IS OPERATED FOR THE CARE OF CHILDREN WHO
    HAVE BEEN DETERMINED TO BE DELINQUENT
    OR IN NEED OF SUPERVISION. THE TERM ALSO
    5. CASELOAD
    A. TOTAL CASELOAD FOR OCTOBER 2002
    ?
    INCLUDES AN ADULT CORRECTIONAL INSTITUTION
    IN WHICH CHILDREN RESIDE.
    B. OF TOTAL OCTOBER CASELOAD, NUMBER OF
    CHILDREN AGED 5 - 17 INCLUSIVE WHO HAD
    RESIDED IN THE INSTITUTION FOR 30 OR MORE
    CONSECUTIVE DAYS
    ?
    SECTION II - BASIS FOR ELIGIBILITY
    YES NO
    1. IS THIS INSTITUTION OPERATED FOR THE CARE OF:
    A. CHILDREN WHO ARE ORPHANED OR HAVE BEEN ABANDONED OR NEGLECTED BY PARENTS/GUARDIANS OR
    PERSONS ACTING IN PLACE OF PARENTS?
    B. CHILDREN WHO HAVE BEEN DETERMINED BY APPROPRIATE STATE OR LOCAL AUTHORITY TO BE
    DELINQUENT OR IN NEED OF SUPERVISION?
    2. IS THIS INSTITUTION A RESIDENTIAL FACILITY IN WHICH CHILDREN ARE UNDER 24 HOUR CARE?
    3. DO THE CASELOAD DATA REPORTED IN ITEM 5B. ABOVE INCLUDE ONLY CHILDREN AGED 5 - 17 INCLUSIVE?
    SECTION III - CERTIFICATION BY CHIEF ADMINISTRATIVE OFFICIAL OF INSTITUTION
    I CERTIFY THAT THE INFORMATION PROVIDED ON THIS FORM IS, TO THE BEST OF MY KNOWLEDGE, COMPLETE AND ACCURATE.
    SIGNATURE
    DATE SIGNED
    TYPED NAME AND TITLE
    TELEPHONE
    (_____) ______-___________
    RETURN THIS COMPLETED REPORT TO YOUR DISTRICT COORDINATOR OF TITLE I.
    SECTION IV - VALIDATION BY DISTRICT COORDINATOR OF TITLE I
    I HAVE REVIEWED THIS FORM AND IT IS, TO THE BEST OF MY KNOWLEDGE, COMPLETE AND ACCURATE.
    SIGNATURE
    DATE SIGNED
    TYPED NAME AND TITLE
    TELEPHONE
    (_____) ______-___________
    ESE 018
    Exp. 08/31/03 DOE Page 1 of 2 Florida Department of Education
    ANNUAL SURVEY OF CHILDREN IN LOCAL INSTITUTIONS FOR NEGLECTED OR DELINQUENT CHILDREN
    OR IN CORRECTIONAL INSTITUTIONS, TITLE I
    GENERAL INSTRUCTIONS
    The purpose of this annual survey is to provide the Florida Department of Education with current information on the location and
    number of children living in institutions for neglected or delinquent children, or in correctional institutions. The information collected will
    be used for purposes of the Title I formula for computing allocations for local educational agencies.
    Institutions in which education is provided by a state agency should be submitted on ESE 019, Annual Report of Children in State
    Agency Institutions for Neglected or Delinquent Children, Adult Correctional Institutions, and Community Day Programs for Neglected
    or Delinquent Children, Title I.
    A separate report should be completed for each institution that meets the requirements of the definitions in the Title I Regulations.
    (Shown in Section I., Item 2.)
    In the case of group homes under one administration office, one report can be prepared for all the homes which are located in the
    same school district. However, there should be an attachment to the form which lists for each home the address and the caseload
    data as required in Section I., Items 5A. and B. A separate report should be filed for each school district.
    SPECIFIC INSTRUCTIONS
    SECTION I - INSTITUTION AND SCHOOL DISTRICT
    1. NAME AND ADDRESS OF INSTITUTION - Enter legal name and address of institution. If the name of the institution has changed
    since last year, please show old name in parenthesis.
    2. TYPE OF INSTITUTION - Mark only one box to identify the type of institution being reported. If the institution serves both
    neglected and delinquent children, for classification purposes identify the majority of the children. If an institution does not meet
    the definition of institutions cited in the Title I Regulations, it SHOULD NOT BE INCLUDED for the purposes of this survey.
    3. NAME OF PUBLIC SCHOOL DISTRICT - Enter the name of the school district in which the children residing in this institution
    attend schools. Since allocations are computed in the Florida Department of Education by the district, it is very important to
    accurately identify the district.
    4. LEGAL OR ADMINISTRATIVE BASIS FOR DESIGNATION OF THIS TYPE OF INSTITUTION - Please mark appropriate box.
    5. CASELOAD DATA - (A) Enter the total number of residents in this institution during the period October 1 through October 31,
    2002, or any portion thereof; and (B) enter the total number of residents, aged 5 - 17 inclusive, who during the month of October
    2002, had resided in the institution for 30 or more consecutive days, one of which was during the month of October. These data
    will be used in the Title I formula for computation of grants. There should be records available to support the caseload data
    reported in this item since this count generates Title I funds and is subject to audit.
    Neglected or delinquent children who are eligible for programs for handicapped children may be counted for grant determination
    under both programs and may be served under both programs.
    SECTION II - BASIS FOR ELIGIBILITY
    1. - 3. If the answer for any item is "No," please explain on a separate sheet, on what basis the children in this institution should be
    counted for local educational agency allocation purposes.
    SECTION III - CERTIFICATION BY CHIEF ADMINISTRATIVE OFFICIAL OF INSTITUTION
    This section must be signed by the Chief Administrative Official of the institution to certify that the information reported is complete and
    accurate. Return completed report to your District Coordinator of Title I.
    SECTION IV - VALIDATION BY DISTRICT COORDINATOR OF TITLE I
    This section must be signed by the District Coordinator of Title I. Validated reports should be returned to Title I/ Migrant Programs,
    Bureau of Equily, Safety, and School Support, Florida Department of Education, 325 West Gaines Street, Room 352, Tallahassee,
    Florida 32399-0400, (850) 487-3530, SunCom 277-3530.
    ESE 018 DOE Page 2 of 2

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