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THE UNIVERSITY OF THE STATE OF NEW YORK
THE STATE EDUCATION DEPARTMENT

1. Please provide all information requested. Do not omit any information as it will significantly delay the Department’s ability to process your request. Requests for the intercept of State aid will not be processed until all required information has been submitted.
2. A separate spreadsheet must be completed for each district against which you are making a claim.
3. Do not make claims for a State aid intercept unless the district in question is more than 30 days in arrears.
4. For all students, you must provide the following information:

• Student name
• Entry date (i.e., the date on which the student began classes at the charter school during the school year in question)
• Withdrawal date from the charter school, if applicable
• The student’s FTE count (use the FTE calculator on the Department’s State Aid webpage at http://stateaid.nysed.gov/calcFTE.htm)

     5.  For students receiving special education, in addition to the above, you must also provide the following information:

• Level of service (e.g., consultant teacher only, < 20%, 20%, 60%)
• Placement (e.g., inclusion, resource room)

     6.  Please also provide evidence (e.g., copies of letters to/from the district in question) of the charter school seeking payment and, if applicable, the district’s refusal to pay.

    7.   You should refer to Section 2856 of the Education Law and Part 119.1 of Commissioner’s Regulations for additional information regarding the financing of charter schools.

    8.   Submit an original and one copy to:

Rec. by PSCP:_________________ Initials:______________

Check if Incomplete:_____ All data received:___________

Sent to OSA:__________________ Received by OSA:_____________