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{"sheet":"Instructions","index":0,"n_rows":74,"n_cols":11,"rows_kept":74,"cut":false,"hidden":false,"merged":[[20,2,20,13],[22,1,22,13],[29,2,29,13],[71,1,71,7],[72,1,72,7],[71,8,71,12],[72,8,72,12],[31,1,31,13],[35,1,35,13],[26,2,26,13],[52,4,52,10],[27,1,27,13],[25,1,25,13],[23,2,23,13],[33,1,33,13],[28,1,28,13],[18,1,18,13],[19,1,19,13],[10,1,10,13],[12,2,12,13],[13,3,13,13],[1,1,1,13],[2,1,2,13],[6,1,6,13],[8,1,8,13],[17,1,17,13],[3,1,3,10],[15,3,15,13],[5,1,5,13],[14,3,14,13],[30,2,30,13],[32,1,32,13],[74,1,74,13],[69,1,69,13],[70,1,70,13],[36,1,36,13],[37,1,37,13],[73,1,73,7],[73,8,73,12],[60,4,60,10],[42,2,42,13],[44,4,44,10],[40,1,40,13],[41,2,41,13],[39,1,39,13]]}
[]
[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,"GENERAL"]
[null,"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 location and number of children who live in local institutions for neglected or delinquent (N or D) children or who are in local adult correctional facilities.  The information collected will be used to determine allocations for Title I, Parts A and D funding.  Please complete all information requested."]
[]
[null,"A separate report should be completed for each institution that meets the requirements of the definitions in the Title I statute Section 1432(1) and (4) of ESEA."]
[]
[null,"Complete all elements of the Blue Form and Signature Page.  The Student Count Verification Form (sheet \"StudentCount\") can be used to assist in verifying that each student meets the required criteria to be included in the 30 Day Count."]
[]
[null,null,"Children must meet ALL of the following criteria to be included in the count:"]
[null,null,null,"- live in a locally operated institution for neglected or delinquent children, or an adult correctional institution"]
[null,null,null,"- are age 5-17, inclusive, and"]
[null,null,null,"- live in the residential program for at least one day during a 30 consecutive day period, at least one day of which falls in the month of October 2020."]
[]
[null,"SPECIAL INSTRUCTIONS - BLUE FORM"]
[null,"SECTION A. Institution and School District"]
[null,"I.  Name and Address of Institution:"]
[null,null,"Enter legal name and address of institution.  If the name of the institution has changed since last year, please show the old name in parentheses."]
[]
[null,"II.  Name of Local Education Agency:"]
[null,null,"Enter the name of the school district in which the institution is located.  Since allocations are computed for each district by ED, it is very important to identify the district in which the institution is located."]
[]
[null,"III.  Type of Institution:"]
[null,null,"Check only one box to identify the type of institution being reported.  Please note that the category of an institution should not change from year to year unless there has been an official change in the purpose for which the institution is operated.  For example, if an institution is operated for the care of neglected children, but the majority of the children residing in the institution during October are children adjudicated to be delinquent, the children in that institution should still be reported as neglected children until its charter or purpose is officially changed to show that it is an institution operated for the care of delinquent children.  Consistency in reporting from year to year is necessary because changing the category of an institution each year based on the category of the majority of children served affects the hold-harmless allocations and eligibility under the Title I, Part A formulas.  If an institution does not meet the definition of institutions cited in the Title I statute it SHOULD NOT BE INCLUDED for purposes of this survey."]
[null,"SECTION B. Administrative Table"]
[null,"Use the table in this section to report the eligible student count."]
[null,null,"•    Identify a 30 consecutive day count window one day of which is in October 2020."]
[null,null,"•    Students must meet all criteria in order to be included in the count."]
[]
[null,"SECTION C. Certification by Chief Administrative Official of Institution and LEA"]
[null,"This report must be electronically signed by the Chief Administrative Officials of the Institution and LEA to certify that the information reported is complete and accurate.  Forms without electronic signatures will be returned."]
[]
[null,"SPECIAL INSTRUCTIONS - SIGNATURE PAGE"]
[null,"SECTION C. Certification by Chief Administrative Official of Institution and LEA"]
[null,"This page must be printed and signed by the Chief Administrative Officials of the Institution and LEA to certify that the information reported 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,"DETERMINING 30-DAY COUNT WINDOW"]
[null,"Select a 30-day count window and conduct the count.  Shaded days on the calendar below indicate those that could be included in the 30-day consecutive count window."]
[null,null,"• The count window must be 30 consecutive days in length."]
[null,null,"• The count window must include at least one day in October 2020."]
[]
[null,null,null,null,"September 2020"]
[null,null,null,null,"S","M","T","W","T","F","S"]
[null,null,null,null,null,null,1,2,3,4,5]
[null,null,null,null,6,7,8,9,10,11,12]
[null,null,null,null,13,14,15,16,17,18,19]
[null,null,null,null,20,21,22,23,24,25,26]
[null,null,null,null,27,28,29,30]
[]
[null,null,null,null,"October 2020"]
[null,null,null,null,"S","M","T","W","T","F","S"]
[null,null,null,null,null,null,null,null,1,2,3]
[null,null,null,null,4,5,6,7,8,9,10]
[null,null,null,null,11,12,13,14,15,16,17]
[null,null,null,null,18,19,20,21,22,23,24]
[null,null,null,null,25,26,27,28,29,30,31]
[]
[null,null,null,null,"November 2020"]
[null,null,null,null,"S","M","T","W","T","F","S"]
[null,null,null,null,1,2,3,4,5,6,7]
[null,null,null,null,8,9,10,11,12,13,14]
[null,null,null,null,15,16,17,18,19,20,21]
[null,null,null,null,22,23,24,25,26,27,28]
[null,null,null,null,29,30]
[]
[]
[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,null,"Colorado Department of Education"]
[null,null,null,null,"Title I, Part D, Subpart 2"]
[null,null,null,null,"Annual Survey of Children in Local Institutions for Neglected or Delinquent Children"]
[null,null,null,null,"October 2020 Count for Determining SY 2021-2022 Allocations"]
[]
[null,"Failure to submit this report will result in the loss of funds to provide services to meet the educational needs of children residing in this institution."]
[null,"Refer to the \"Instructions\" sheet for instructions on completing this form."]
[]
[null,"SECTION A. Institution and School District"]
[null,"I.  Legal Name and Address of Institution (including zip code):",null,null,null,null,null,null,null,"III.  Type of Institution (Check only one box to identify the type of Institution being reported):"]
[]
[null,null,"Institution Name",null,null,null,null,null,null,null,"A.                    \"An Institution for Neglected Children\" means a public or private residential facility, other than a foster home, that is operated 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,"Mailing Address"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"OR"]
[null,null,"City",null,null,"State","ZIP"]
[]
[null,null,null,null,null,null,null,null,null,null,"B.                    \"Institution for Delinquent Children\" means a public or private residential facility for the care of children who have been adjudicated to be delinquent or in need of supervision."]
[null,"II.  Name of Local (public) school district in which the institution is located:"]
[]
[null,null,"LEA Name",null,null,null,"LEA Number"]
[]
[null,"SECTION B. Administrative Table"]
[null,"Children must meet ALL of the following criteria to be included in the count:",null,null,null,null,null,null,null,null,"Dates of Count Period",null,null,"Total Number of Children who meet all of the criteria"]
[null,null,"- live in a local institution for neglected or delinquent children, or an adult correctional institution,"]
[null,null,"- are age 5-17, inclusive, and"]
[null,null,"- live in the residential program for at least one day during a count period of 30 consecutive days, at least one of which falls in the month of October 2020."]
[null,null,null,null,null,null,null,null,null,null,null,"to",null,"Count =",null,null,null,null,{"$f":"IF(K31=\"\",30,IF(M31=\"\",30,M31-K31+1))","v":30},{"$f":"IF(K31=\"\",TRUE,IF(StudentCount!D15=\"\",TRUE, IF(K31=StudentCount!D15,TRUE,FALSE)))","v":true},{"$f":"IF(K31=\"\",TRUE,IF(M31=\"\",TRUE,IF(K31>=DATE(2020,11,1),FALSE,IF(M31<=DATE(2020,9,30),FALSE,TRUE))))","v":true}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"S31&\" days\"","v":"30 days"},{"$f":"IF(M31=\"\",TRUE,IF(StudentCount!G15=\"\",TRUE, IF(M31=StudentCount!G15,TRUE,FALSE)))","v":true}]

{"sheet":"SignaturePage","index":2,"n_rows":20,"n_cols":13,"rows_kept":20,"cut":false,"hidden":false,"merged":[[19,1,19,3],[19,4,19,13],[6,1,6,2],[14,1,14,2],[6,12,6,13],[14,12,14,13],[16,1,16,3],[16,4,16,13],[17,1,17,3],[17,4,17,13],[18,1,18,3],[18,4,18,13],[11,1,11,3],[15,1,15,2],[7,4,7,13],[15,4,15,13],[12,1,12,13],[13,1,13,13],[8,1,8,3],[8,4,8,13],[9,1,9,3],[9,4,9,13],[10,1,10,3],[11,4,11,13],[10,4,10,13],[1,1,1,13],[2,1,2,13],[3,1,3,13],[5,1,5,13],[7,1,7,2],[4,1,4,2],[4,3,4,10],[4,12,4,13]]}
[]
[null,"SECTION C. Certification by Chief Administrative Official of Institution and LEA"]
[null,"A knowingly false claim on this report is a criminal offense under U.S. Code, Title 18, Section 1001 or Section 287"]
[null,"I certify that the information provided on this form is complete and accurate:"]
[null,"Institution:",null,{"$f":"IF(BlueForm!C12=\"\",\"\",BlueForm!C12)","v":""},null,null,null,null,null,null,null,"Count:",{"$f":"IF(BlueForm!P31=\"\",\"\",BlueForm!P31)","v":""}]
[null,"INSTITUTION CHIEF ADMINISTRATOR CONTACT INFORMATION"]
[null,"Signature:",null,null,null,null,null,null,null,null,null,"Date:"]
[null,"Printed Name:"]
[null,"Title:"]
[null,"E-mail address:"]
[null,"Address, City, Zip:"]
[null,"Phone:"]
[]
[null,"LEA - TITLE I COORDINATOR CONTACT INFORMATION"]
[null,"Signature:",null,null,null,null,null,null,null,null,null,"Date:"]
[null,"Printed Name:"]
[null,"Title:"]
[null,"E-mail address:"]
[null,"Address, City, Zip:"]
[null,"Phone:"]

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[]
[" ","Colorado Department of Education"]
[null,"Title I, Part D, Subpart 2"]
[null,"Neglected or Delinquent 30 Day Student Count Verification Form"]
[null,"October 2020 Count for Determining FY 2021-2022 Allocations"]
[]
[]
[null,"Children must meet ALL of the following criteria to be included in the count:"]
[null,null,"1) live in a local institution for neglected or delinquent children, or an adult correctional institution,"]
[null,null,"2) are age 5-17, inclusive, and"]
[null,null,"3) live in the residential program for at least one day during a count period of 30 consecutive days, at least one of which was in October 2020"]
[]
[null,null,"District:"]
[null,null,"Institution Name:"]
[null,null,"Identified 30 Day Count Window:",null,null,"to",null,null,null,null,null,{"$f":"IF(D15=\"\",30,IF(G15=\"\",30,G15-D15+1))","v":30},{"$f":"IF(D15=\"\",TRUE,IF(BlueForm!K31=\"\",TRUE, IF(D15=BlueForm!K31,TRUE,FALSE)))","v":true},{"$f":"IF(D15=\"\",TRUE,IF(G15=\"\",TRUE,IF(D15>=DATE(2020,11,1),FALSE,IF(G15<=DATE(2020,9,30),FALSE,TRUE))))","v":true}]
[null,null,null,null,null,null,null,null,null,null,null,{"$f":"L15&\" days\"","v":"30 days"},{"$f":"IF(G15=\"\",TRUE,IF(BlueForm!M31=\"\",TRUE, IF(G15=BlueForm!M31,TRUE,FALSE)))","v":true}]
[null,null,"NOTE: In order for the validation below to work, a 30-Day Count Window must first be entered in the cells above"]
[null,null,"Student Name","Student ID: SASID or Out of State Student (OOSS) Number","Student Date of Birth","Live in a Residential Program","Date of Facility Placement","Withdrawal Date","Student Meets Criteria 1-3?\n(Auto-populates \"YES\" or Error)"]
[null,null,null,null,"M/D/YYYY","Y/N","M/D/YYYY","M/D/YYYY"]
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[null,null,null,null,null,null,null,null,{"$f":"IF(E21=\"\",\"\",IF(F21=\"\",\"\",IF(G21=\"\",\"\",IF(T21=\"\",\"YES\",T21))))","v":""},null,null,{"$f":"DATEDIF(E21, $D$15,\"y\")","v":0},{"$f":"DATEDIF(E21, $G$15,\"y\")","v":0},{"$f":"IF(G21>$G$15,FALSE,IF(H21=\"\",TRUE,IF(H21<$D$15,FALSE,TRUE)))","v":true},{"$f":"IF(E21=\"\",\"\",IF(M21<5,\"Age <5\",IF(L21>17,\"Age >17\",\"\")))","v":""},{"$f":"IF(O21=\"\",\"\",IF(Q21=\"\",IF(S21=\"\",\"\",\", \"),\", \"))","v":""},{"$f":"IF(F21=\"\",\"\",IF(F21=\"N\",\"Not in res. program\",\"\"))","v":""},{"$f":"IF(Q21=\"\",\"\",IF(S21=\"\",\"\",\", \"))","v":""},{"$f":"IF(N21=TRUE,\"\",\"Not in facility during count\")","v":""},{"$f":"IF(O21=\"\",\"\",O21)&IF(P21=\"\",\"\",P21)&IF(Q21=\"\",\"\",Q21)&IF(R21=\"\",\"\",R21)&IF(S21=\"\",\"\",S21)","v":""}]
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