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[]
[null,"SURVEY SUBMISSION"]
[null,"Do not send this template via email.  Forms must be submitted electronically using Syncplicity by December 4, 2020."]
[]
[null,"Note: Signature page must be printed and signed, and submitted in addition to template"]
[]
[null,"PURPOSE & REQUIREMENTS"]
[null,"PURPOSE: The purpose of the annual report is to provide the U.S. Department of Education (ED)  and the Colorado Department of Education with accurate information on the number of children enrolled in a regular program of instruction in eligible State-operated institutions for N or D children, adult correctional institutions, and community day programs for N or D children.  The information collected will be used to determine allocations for Title I, Part D funding.  Please complete all information requested."]
[]
[null,"REQUIREMENTS: This report is required annually for all State educational agencies.  No sampling or estimating is to be used in preparing this report.  Since these data will generate Federal funds, they are subject to audit and must be supportable from documented records."]
[]
[null,"WORKSHEET INSTRUCTIONS - TAN FORM"]
[null,"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"]
[null,"PART I - INSTITUTION AND STATE AGENCY"]
[null,"Enter the names of the institution and State agency.  Please note: a separate form must be completed for each institution."]
[null,"PART II - BASIS FOR ELIGIBILITY"]
[null,"Respond \"yes\" or \"no\" to each of the three questions.  If the answer is no to any one of these questions, the institution or community day program does not qualify."]
[null,null,"•    In question 1 a \"regular program of instruction\" means an education program (not beyond grade 12) in an institution or a community day program for neglected or delinquent children that consists of classroom instruction in basic school subjects such as reading, mathematics, and vocationally oriented subjects, and that is supported by non-Federal funds.  Neither the manufacture of goods within the institution nor activities related to institutional maintenance are considered classroom instruction."]
[null,null,"•    In question 2 a \"State agency\" means an agency of State government responsible for providing free public education for children in institutions for neglected or delinquent children, community day programs for neglected or delinquent children, and adult correctional institutions."]
[null,null,"•    In question 3 an \"average length of stay\" is calculated by determining the length of time each child entering the institution stays and dividing that number by the total number of children passing through that institution during a given year.  The average length of stay for all children in the institution must equal at least 30 days.  An individual child in an institution, however, would not necessarily have to stay for 30 days."]
[null,"PART III - TYPE OF INSTITUTION, ENROLLMENT, AND COUNT DATE"]
[null,"Category"]
[null,null,"Check the category that fits the definition of the institution.  Do not report institutions that do not meet any of the four definitions."]
[]
[null,"Enrollment"]
[null,null,"For the category of institution checked, furnish the number of children up to age 21 (i.e., through age 20), enrolled in a regular program of instruction on a date in calendar year 2020 specified by the State agency.  The date specified by the State agency must be consistent for all institutions or community day programs operated by the State agency, and the date must represent a school day within calendar year 2020."]
[null,null,"In order to be counted as enrolled, a child must be enrolled in a State-funded regular program of instruction for at least:"]
[null,null,null,"•    20 hours per week if in an institution for neglected or delinquent children or a community day program for neglected or delinquent children; or"]
[null,null,null,"•    15 hours per week if in an adult correctional institution."]
[null,"PART IV - ADJUSTED ENROLLMENT TO REFLECT THE RELATIVE LENGTH OF THE STATE AGENCY'S ANNUAL PROGRAM"]
[null,"The SEA must adjust the enrollment data for each institution to account for the relative length of a State agency's annual educational program in such institution.  The enrollment determined in Part III, therefore, is multiplied by the number of days in the year that the educational program operates.  That number is then divided by 180 to determine the adjusted enrollment."]
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[null,"SIGNATURE PAGE INSTRUCTIONS"]
[null,"PART V - CERTIFICATION"]
[null,"The appropriate institution and State agency official must sign certifying that the information provided meets the requirements of Title I, Part D, Subpart 1, and is complete and accurate.  A scanned copy of the signature page must be submitted in addition to the template through Syncplicity.  (Note, because these data will generate Federal funds, they are subject to audit and must be supportable from documented records.)"]
[]
[null,"CONTACT INFORMATION"]
[]
[null,"Alan Shimmin",null,null,null,null,null,null,"Michelle Prael"]
[null,"303-866-6209",null,null,null,null,null,null,"303-866-6998"]
[null,"shimmin_a@cde.state.co.us",null,null,null,null,null,null,"prael_m@cde.state.co.us"]

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[]
[" ",null,null,"Colorado Department of Education"]
[null,null,null,"Title I, Part D, Subpart 1"]
[null,null,null,"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"]
[null,null,null,"FY 2021-2022"]
[]
[null,"PART I - INSTITUTION AND STATE AGENCY"]
[null,null,"1.  Name and address of institution, community day program, or adult correctional institution:",null,null,null,null,null,null,null,"2.  Name and address of State agency:"]
[]
[null,null,"Institution/Program Name",null,null,null,null,null,null,null,"State Agency Name"]
[]
[]
[null,null,"Mailing Address",null,null,null,null,null,null,null,"Mailing Address"]
[]
[]
[null,null,"City",null,null,"State","ZIP",null,null,null,"City",null,null,"State","ZIP"]
[]
[null,"PART II - BASIS FOR ELIGIBILITY"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"YES","NO"]
[null,null,"1.  Is a regular program of instruction provided for the children in the institution or community day school?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,false]
[null,null,"2.  Is the State agency responsible for providing free public education for the children in the institution or community day program?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,false]
[null,null,"3.  Is the average length of stay in the institution or community day program at least 30 days?",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,false]
[]
[null,"IF ANSWER TO ALL THREE QUESTIONS ABOVE IS YES, PROCEED TO PART III.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(S20=TRUE,IF(S21=TRUE,IF(S22=TRUE,TRUE,FALSE),FALSE),FALSE)","v":false},{"$f":"IF(T20=TRUE,TRUE,IF(T21=TRUE,TRUE,IF(T22=TRUE,FALSE)))","v":false}]
[]
[null,"PART III - TYPE OF INSTITUTION, ENROLLMENT, AND COUNT DATE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(T24=FALSE,IF(S24=FALSE,FALSE,TRUE),TRUE)","v":false}]
[null,"CATEGORY\n(Check one)",null,null,null,null,null,null,null,null,null,null,null,null,"Number of Children Under 21 Enrolled in a Regular Program of Instruction Supported by State Funds for at Least"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"20 hours per week","15 hours per week"]
[null,null,null,"INSTITUTION FOR NEGLECTED CHILDREN",null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,null,null,"A public or private residential facility, other than a foster home, that is operated primarily for the care of children who have been committed to the institution or voluntarily placed in the institution under applicable State law, due to abandonment, neglect, or death of their parents or guardians.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,null,null,"INSTITUTION FOR DELINQUENT CHILDREN AND YOUTH",null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[null,null,null,"A public or private residential facility that is operated primarily for the care of children who have been adjudicated to be delinquent or in need of supervision.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(S29=TRUE,TRUE,IF(S30=TRUE,TRUE,IF(S31=TRUE,TRUE,IF(S32=TRUE,TRUE))))","v":false}]
[]
[null,null,null,"COMMUNITY DAY PROGRAM"]
[null,null,null,"A regular program of instruction provided by a State agency at a community day school operated specifically for neglected or delinquent children."]
[]
[null,null,null,"ADULT CORRECTIONAL INSTITUTION"]
[null,null,null,"A facility in which persons are confined as a result of a conviction for a criminal offense, including persons under 21 years of age."]
[]
[null,null,null,"COUNT DATE IN CALENDAR YEAR 2020 SPECIFIED BY STATE AGENCY",null,null,null,null,null,null,null,null,null,null,"DATE"]
[null,null,null,null,"This date must represent a school day within the calendar year"]
[]
[]
[null,"PART IV - ADJUSTED ENROLLMENT TO REFLECT THE RELATIVE LENGTH OF THE STATE AGENCY'S ANNUAL PROGRAM"]
[]
[null,null,null,"Enrollment\n(Part III)",null,"No. of Days Per Year Educational Program Operates",null,null,null,null,null,"Adjusted Enrollment"]
[]
[null,null,null,{"$f":"SUM(O29,O32,O35,P38)","v":0},"X",null,"DIVIDED\nBY",null,180,null,"=",{"$f":"(D49*F49)/180","v":0}]

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[]
[null,"PART V - CERTIFICATION"]
[null,"I certify that the information provided meets the requirements of Title I, Part D, Subpart 1 and is complete and accurate."]
[null,"Institution:",null,{"$f":"IF(TanForm!C9=\"\",\"\",TanForm!C9)","v":""},null,null,null,null,null,null,null,"Adjusted Enrollment:",null,null,{"$f":"IF(TanForm!L49=0,\"\",TanForm!L49)","v":""}]
[null,"Signature:",null,null,null,null,null,null,null,null,null,null,null,"Date:"]
[null,"Printed Named:"]
[null,"Title:"]
[null,"E-mail address:"]
[null,"Address, City, Zip:"]
[null,"Phone:"]