MEMORANDUM

FLORIDA DEPARTMENT OF EDUCATION
SHAN GOFF, CHIEF
CHARLIE CRISTBUREAU OF INSTRUCTIONAL SUPPORT
REPORT OF RESIDENTIAL CONTRACT COSTS

FLORIDA DEPARTMENT OF EDUCATION

CHARLIE CRIST

Commissioner

December 16, 2002

M E M O R A N D U M #02-99

District ESE Directors

SHAN GOFF, CHIEF

BUREAU OF INSTRUCTIONAL SUPPORT

AND COMMUNITY SERVICES

2002 - 2003 Report of Residential Contract Costs

(Form # ESE 085)

When a school district contracts with a nonpublic residential school or community facility

program to provide special education and related services to a student with disabilities, Rule 6A-

6.0361(7)(f), FAC, requires the district to submit a copy of the contract to the Department of

Education. We also require that when submitting

contracts for residential placement

submit a copy of form Report of Residential Contract Costs (Form # ESE 085) which is

enclosed. Please complete the enclosed form and return it to Eileen Amy, Administrator, ESE

Program Administration and Quality Assurance by January 31, 2003.

When contracts with nonpublic residential schools are used, please remember the following:

Annually, a copy of the contract(s) signed by all participating parties must be filed with the

Bureau of Instructional Support and Community Services.

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 non-residential programs

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

agreements, or cooperative agreements related to the placement of school district staff in

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An affirmative action/equal opportunity employer

Memorandum #02-99

December 16, 2002

community facilities; nor does it include contractual agreements related to services provided to students

(nondisabled and disabled) in juvenile justice facilities.

Your continued cooperation in implementing these procedures is appreciated.

Superintendents

Please return annually to:

Administrator, Program Administration and

Quality Assurance

Bureau of Instructional Support and

Community Services

Florida Department of Educati

325 West Gaines Street, Room 614

Tallahassee, Florida 32399-0400

(850) 488-1216, SunCom 278-1216

FLORIDA DEPARTMENT OF EDUCATION

STUDENT ACHIEVEMENT AND ARTICULATION

BUREAU OF INSTRUCTIONAL SUPPORT AND

COMMUNITY SERVICES

REPORT OF RESIDENTIAL CONTRACT COSTS

1. School District:

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)

10. Does Another Agency Participate in the Cost of Placement?

11. If Yes, List Cost to Each Agency and Name of Agency:

Cost: $______________________

_________________________________________________

Cost: $______________________

_________________________________________________

12. Is Any Insurance Paying Part of Contract?

13. If Yes, List Amount Paid and Name of Insurance Company: $

_____________________

14. Certifying Signature:_______________________________________

_________________________

ESE Administrator or Designee

REPORT OF RESIDENTIAL CONTRACT TERMINATION

1. Date of Termination: ____________________________________

2. FTE Count(s) Used During the Contract Period:

3. Reason for Termination: ________________________________________________________________________

4. Present Location of Student: ____________________________________________________________________

5. Amount of Actual Expenditure by School District:

$ __________________________________________

Agency _______________________________________

$ __________________________________________

Agency _______________________________________

$ __________________________________________

Florida Department of Education

Florida Department of