Program Student Per Pupil School Participation Program Services Description Name Count Amount Allocation (See Allowable Activities Guidance) $ $ Receiving Services Title I Declining Services Part A No Eligible Students # of Students Living in Title I Attendance Areas Title I $ $ Receiving Services Part A Declining Services Parent and No Eligible Students # of Family District Allocation is Students Living Engagement Less Than $500,000 in Title I No Reserve – Attendance Required Areas Title II $ $ Receiving Services Part A Declining Services Out of District Private # of Students in School Grades K-12, Regardless of LEA of Residence $ $ Receiving Services Title III Declining Services Part A English No Eligible Students # of ELL Language Out of District Private Students in Learner School Grades K-12, Regardless of LEA of Residence Title III $ $ Receiving Services Part A Declining Services Immigrant No Eligible Students # of Immigrant Out of District Private Students in School Grades K-12, Regardless of LEA of Residence Title IV $ $ Receiving Services Part A Declining Services Out of District Private # of Students in School Grades K-12, Regardless of LEA of Residence Private School Date signed: Administrator’s Signature: LEA Name: Private School Name: SECTION 5: DISAGREEMENT If a LEA disagrees with the views of private school officials with respect to the topics of consultation listed above, the LEA must provide
Program Name Student Count Per Pupil Amount School Allocation Participation Program Services Description (See Allowable Activities Guidance) Title I Part A # of Students Living in Title I Attendance Areas $ $ Receiving Services Declining Services No Eligible Students Title I Part A Parent and Family Engagement # of Students Living in Title I Attendance Areas $ $ Receiving Services Declining Services No Eligible Students District Allocation is Less Than $500,000 – No Reserve Required Title II Part A # of Students in Grades K-12, Regardless of LEA of Residence $ $ Receiving Services Declining Services Out of District Private School Title III Part A English Language Learner # of ELL Students in Grades K-12, Regardless of LEA of Residence $ $ Receiving Services Declining Services No Eligible Students Out of District Private School Title III Part A Immigrant # of Immigrant Students in Grades K-12, Regardless of LEA of Residence $ $ Receiving Services Declining Services No Eligible Students Out of District Private School Title IV Part A # of Students in Grades K-12, Regardless of LEA of Residence $ $ Receiving Services Declining Services Out of District Private School Private School Administrator’s Signature: Date signed: LEA Name: Private School Name: SECTION 5: DISAGREEMENT If a LEA disagrees with the views of private school officials with respect to the topics of consultation listed above, the LEA must provide