F-3 - New York City



right-334000-14511246813300DIVISION OF EARLY CARE AND EDUCATIONCHILD CARE PARENT ADVISORY COMMITTEE (PAC)ELECTION FORMSTABLE OF CONTENTSF-3Classroom Election Attendance SheetF-4Classroom Committee Representatives FormElection Certification FormF-13Parent Advisory Committee Report Form727710015621000Appendix D Parent Elections Timetable944360573500right14016900F-3Classroom Election Attendance Sheet Submit on Friday, October 6, 2017 Program Name: ________________________________________ Date ______________Program Address_______________________________________ Telephone _____________Email ________________________________ Fax Number_____________Parent Election Coordinator _________________________ Telephone ______________State the number of children enrolled in this class at the time of classroom election ________Type of Election:[ ] Open Vote Meeting [ ] Closed Ballot Meeting [ ] All Day Voting (Ballot Box)Note: A quorum is based on 50% +1 of your classroom enrollment at the time of the election.*Please maintain a copy of your meeting notice (i.e. flyer, letter or poster) with a copy of the agenda on file.1194435150495COMPLETE ONE FORM PER CLASSROOM00COMPLETE ONE FORM PER CLASSROOMName (please print)SignatureClassroom Child’s Nameright11176000left52475900F-4 Classroom Committee Representatives Form Submit on Friday, October 6, 2017Agency ____________________________________________________ Date _______________Agency Address ________________________________ # Classrooms: __________________Parent Election Coordinator Name___________________________________________________ E-Mail____________________________________________ Tel_________________________right133516COMPLETE ONE FORM PER CLASS00COMPLETE ONE FORM PER CLASSName of Class: __________________# Enrolled: ________ Teacher: _____________________ Chairperson’s Name _______________________________ Child’s Name_________________Home Mailing Address: ___________________________________________ Apt. __________ Borough __________ Zip Code _________ Email Address __________________________ Vice-Chairperson’s Name ____________________________ Child’s Name________________Home Mailing Address: _____________________________________________ Apt. _________ Borough __________ Zip Code _________ Email Address ___________________________ Secretary’s Name _______________________________ Child’s Name___________________Home Mailing Address: _____________________________________________ Apt. _________ Borough __________ Zip Code _________ Email Address ___________________________ Treasurer’s Name ______________________________ Child’s Name______________________Home Mailing Address: _____________________________________________ Apt. _________ Borough __________ Zip Code _________ Email Address ___________________________ Alternate Name _______________________________ Child’s Name___________________Position ______________________________________Home Mailing Address: _____________________________________________ Apt. __________ Borough __________ Zip Code _________ Email Address ____________________________Use more pages as needed.-25686777900 PARENT ADVISORY COMMITTEE (PAC) ELECTION CERTIFICATION FORM DUE BY OCTOBER 13, 201763836812330000Program Name:FISCAL NO.BOARD NAME:Address:Address:Borough: Zip Code:Borough: ZIP Code:Director:Board Chairperson:Phone No.: Fax No.:Phone No.:PAC Orientation Date:MonthDayYear Orientation Conducted by:[ ]PAC Election Date:[ ] Balloting (A.M. & P.M.)[ ] Meeting (Evening/PM)Monitor: (1)Monitor: (2)SIGNATURE: ( I HEREBY CERTIFY)SIGNATURE: ( I HEREBY CERTIFY) _________________________________________ hereby certifies that the election reported herein was properly (Name of Agency) conducted based on and adequate orientation to the ACS/DCC parent involvement guidelines, and provision for all parents to have open access to the election process.No. Of Parents Enrolled [ ] No. Of Parents Voting [ ]Quorum [ ] YES [ ] NOELECTED OFFICERS: (TYPE OR PRINT NAME CLEARLY)ADDRESS/BORO./ZIP CODECHAIRPERSON:EMAIL:CO-CHAIRPERSON:EMAIL:CORRESPONDING SECRETARY:EMAIL:TREASURER:EMAIL:NOTES:Balloting can be done during hours of operation (8 AM to 6 PM) or at a PAC meeting if held the same day as balloting. A quorum of parents must be at the meeting when the election is held. A quorum is 50% Plus One of all parents enrolled in the program. Conduct the PAC Elections By October 13, 2017.Submit all parent election forms to:Email Address:HSDAPC@ACS.2783082693600635585311504500F-13Parent Advisory Committee Report Form DUE by October 13, 2017Agency ____________________________________________________ Date _______________Agency Address ________________________________ # Classrooms: __________________Parent Election Coordinator Name___________________________________________________ E-Mail____________________________________________ Tel_________________________Results:ConductedNot ConductedCheck Item(s) Reviewed:Mode of Electionby Paper Ballot Special Meeting Election Minutes Class Minutes PAC Orientation F-3 Classroom Election Attendance Sheet F-4 Classroom Committee Representative Form Total number of representatives to the PAC Committee: ____Was There A Quorum?Yes No If Not, Why? Were All Motions Seconded?Yes No Election MonitorsACS Staff Name/Date ______________________________Self-Monitored Name/Date ______________________________Child Care Director ____________________________________ Date _______________________ left51666900635585311504500Appendix DParent Advisory Committee Timetable for Elections Conduct Parent Orientations by09-8-2017 Complete Classroom Elections by09-22-2017 Conduct PAC Election by10-13-2017REQUIRED ELECTION DOCUMENTATION F3 Classroom Election Attendance Sheet10-6-2017 F4 Classroom Committee Representative Form10-6-2017 F13 Parent Advisory Committee Report Form10-13-2017 Certification Forms due to ACS by10-27-2017Please email or fax completed Parent Election documents to:HSDAPC@ACS. PLEASE NOTE:Timelines is Important! Your program’s submission is used in determining you annual VENDEX score. 15373353431540001423035434594000153733517170400016573505374640Chairperson (President)PAC Committees may elect to Vice-Chairpersonadd sub-committee groups. SecretaryTreasurer 00Chairperson (President)PAC Committees may elect to Vice-Chairpersonadd sub-committee groups. SecretaryTreasurer 1765935802640Division of Early Care and EducationEarly Learn NYC Parent Advisory Committee00Division of Early Care and EducationEarly Learn NYC Parent Advisory Committee29089352174240ParentAdvisoryCommittee(PAC)Members00ParentAdvisoryCommittee(PAC)Members-3657604803140Classroom CParent ClassroomCommittee00Classroom CParent ClassroomCommittee-2914652745740Classroom BParent ClassroomCommittee00Classroom BParent ClassroomCommittee-3657601066800Classroom AParent ClassroomCommittee00Classroom AParent ClassroomCommittee-36576054864000 ................
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