100 North First Street, N-242
Springeld, Illinois 62777-0001
NONPUBLIC SCHOOL CONSULTATION PARTICIPATION FORM
GRANT APPLICATION IN THE
20____-20____ SCHOOL YEAR
(Based on data gathered in FY 20___)
TITLE GRANTS DIVISION
Title I-A Improving Basic Programs Operated By State and Local Education Agencies
Title II-A Preparing, Training, and Recruiting High-Quality Teachers, Principals, or Other School Leaders
Title IV-A Student Support and Academic Enrichment Grants
PUBLIC DISTRICT NAME AND NUMBER PUBLIC REGION, COUNTY, DISTRICT, TYPE CODE
NONPUBLIC SCHOOL NAME NONPUBLIC REGION, COUNTY, DISTRICT, TYPE CODE
NONPUBLIC SCHOOL ADDRESS (Street, City, State, Zip Code) NONPUBLIC TOTAL ENROLLMENT
Please check the appropriate boxes to indicate participation.
Title I-A—Equitable share is based on number of low-income students attending nonpublic schools regardless
of where the schools are based. Services are based on those students in academic need who reside in the
public school district’s boundaries. Estimated number of low-income students ________.
Yes No
Title II-A—Equitable share is based on the total population of the nonpublic schools’ students based within the
public school district’s boundaries regardless of the number of nonpublic students that would attend a district
public school.
Yes No
Title IV-A—Equitable share is based on the total population of the nonpublic schools’ students based within the
public school district’s boundaries regardless of the number of nonpublic students that would attend a district
public school.
Yes No
The following topics must be discussed during the ongoing consultation process:
How the LEA will identify needs.
What services the LEA will offer.
How and when the LEA will make decisions about delivery of services.
How, where, and by whom the LEA will provide services.
How the LEA will academically assess program success.
Size and scope of services. When, including the approximate time of day, services will be provided.
Method of sources of data to determine number of students.
Equitable services the LEA will provide to teachers and families.
Service delivery mechanisms.
Consideration and analysis of the views of the private school ofcials about third party providers and whether the LEA will provide
services directly or through a separate government agency, consortium, entity, or third-party contractor.
How the proportion of funds allocated for equitable services is determined.
Whether to provide equitable services to eligible private school children by pooling funds or on a school-by-school basis.
Whether to consolidate and use funds available for Title I equitable services in coordination with eligible funds available for
equitable services for programs covered under Section 8501 (b).
We agree do not agree that initial timely and meaningful consultation occurred before the LEA made any decision that affected
the equitable participation of eligible private school children in the Title I-A program.
We agree do not agree that initial timely and meaningful consultation occurred before the LEA made any decision that affected
the equitable participation of eligible private school children in the Title II-A program.
We agree do not agree that initial timely and meaningful consultation occurred before the LEA made any decision that affected
the equitable participation of eligible private school children in the Title IV-A program
___________________________________
Date
_____________________________________________
Print Name of Nonpublic, Nonprot School Ofcial
________________________________________________
Original Signature of Nonpublic, Nonprot School Ofcial
ISBE 43-20 (9/17)
Instructions: This form is to be completed by nonpublic school ofcials. The completed form is then to be uploaded into the district’s
ESSA consolidated application by the district.
Use your "Mouse" or "Tab" key to move through the fields and check boxes. After completing last field, save document to hard drive to make future updates or click print button.
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