THE STATE EDUCATION DEPARTMENT



THE UNIVERSI TY OF THE STA TE OF NEW YORKTHE STATE EDUCATION DEPARTMENTOffice of Early Learning (OEL)89 Washington Avenue, Rm. 319 EB, Albany, New York 12234Phone: (518) 474-5807 | Fax: (518) 473-77372018 – 2019 Annual Report for Registered Nonpublic Nursery Schools & KindergartensDue Date: July 31, 2019SCHOOL INFORMATIONSchool NameCheck all that apply? Nursery School? Prekindergarten? Kindergarten ? Montessori School? Parent Cooperative ? Mission of a Church or SynagogueSchool AddressCity and Zip CodeTelephone NumberWeb Address ()School Owner, Director & Administrator InformationComplete page 2REGULATORY AUTHORITYRegistered/ Licensed by a Regulatory Agency?? Office of Children & Family Services (OCFS) ? NYC Dept. of Health & Mental Hygiene (NYC DOHMH) ? N/A (not licensed or registered by a regulatory agency)License # (OCFS) or Permit # (NYCDOH)I verify that the information provided in this report is correct and reflects the current status of program operations.Authorized Signature ________________________________________ Date ____________________Title (print) ________________________________________________FIRE SAFETY REPORTAll nonpublic nursery schools and kindergartens that are registered with the New York State Education Department are required to submit an annual fire inspection report as per Commissioner’s Regulations, Part 125.10 (b). The law states that all NYSED registered nursery schools and kindergartens not licensed by The Office of Children and Family Services (OCFS), those that are located outside of the Big Four and NYC school districts and those who are not part of a college, university or larger elementary school campus, must complete the NYSED Fire Safety Report form. All other registered nurseries and kindergartens must attach a copy of the document that confirms the nursery site passed all fire safety requirements as set forth under their authority.The Fire Safety Report must be submitted by December 1st to: NYS Education Department, Office of Facilities Planning, 89 Washington Avenue – Room 1060 EBA, Albany, NY 12234. In addition, a copy of the Fire Safety Report must be submitted with the Annual Report for Registered Nonpublic Nursery Schools and Kindergartens by July 31st to the Office of Early Learning. The Fire Safety Report form can be downloaded on the Facilities Planning website.By signing below, I am confirming that I have attached a copy of our most recent completed NYSED Fire Safety Report or the equivalent report completed by our regulatory authority to this Annual Report form.Authorized Signature __________________________________________SED USE ONLYRWAR? SED FSR? FSI DOC? NYC DOHMH - PC FID ___________? NR RQD FSRThe University of the State of New YorkVOLUNTARY REGISTERED NONPUBLIC THE STATE EDUCATION DEPARTMENT NURSERY SCHOOLS & KINDERGARTENS Office of Early Learning89 Washington Avenue, Room 319 EBAlbany, New York 12234Site Contact Information FormRevised 03/2018The Education Department’s policy is to use e -mail for all bulk correspondence to registered schools, so it is important that we have the correct email address for your school and all designated staff. Please complete the below in its entirety. In addition, during the school year, this form should be used to report immediately to the Department changes in Educational Director, Administrative Director, and other school contact information. This form can be submitted by e-mail to: oel@ or by via fax to (518) 473 -7737.We appreciate your ongoing attention to this matter. Thank you.School NameEducational Director NameEmail AddressTelephone Number & Ext.Fax Number Administrative Director NameEmail AddressTelephone Number & Ext.Fax NumberOther School Administrator NameTitleEmail AddressTelephone Number & Ext.Fax NumberSite Director(s) NameOwnerBoard PresidentIs the above listed Educational Director new since the 2017-18 school year?? Yes*? No*If yes, please include all of the following documents:Completed Staff Background Form (see page 4)Copy of Teacher Certification CertificateResume or written narrative that provides evidence of instruction?and/or experience in supervision and administration.Is the above listed Administrative Director new as of the 2017-18 school year? ? Yes*? No*If yes, please include a completed Staff Background From School Operation & EnrollmentSchool NameSCHOOL YEAR SESSION & FACILITY HOURS OF OPERATION(Only report for the school year that began in 2018)Date School Began2018Date School Ends2019Time Facility OpensTime Facility ClosesCLASSROOMS & CLASSROOM STAFFTotal # of Classrooms# of Lead Classroom Teachers# of Teacher Assistants# of Classroom Aides# of Parent Assistantsonly for parent cooperativesSTUDENTS SERVEDAges of Students Served? 3 ? 4 ? 5 check all that apply# of Nursery Students*The Voluntary Registration Program is for 3-5-yr-olds ONLY# of Prekindergarten Students(3s are students who turn 3 on or before December 1st)# of Kindergarten Students*Do not include infants or toddlers in the number of studentsTOTAL # OF STUDENTS must provide the total number of 3-5-year-olds servedOf the ABOVE students, how many are identified as:Integrated/InclusionStudents with disabilitiesStudents who speak a language other than English at homeSIGNIFICANT CHANGESMark all areas below that had significant changes during the 2018-2019 school year and then complete pages 7-10 where appropriate, if none check the last box (do not leave blank/unanswered):CHANGE IN STAFFING? ? Yes? NoIf yes, the Staff Background Form on page 4 must be completed for each new hire, reassignment, promotion, etc. and the summary of the staffing change must be provided on page 6 in the space provided. ? Educational Program? Health Policies? Emergency Procedures? Classroom Environment? Hours of Operation? Student Enrollment? Nutrition Policies? Family Partnerships ? Outdoor Play Environment? Facilities Management - Construction and/or Renovations? No Significant Changes Pages 9 - 10 must be completed for any planned &/or completed indoor &/or outdoor construction or major renovation projects.Staff Background FormRevised 03/2018(Duplicate this form as needed)Education, Training and Professional Experience of Certified and Noncertified Staff Members (Including individuals certified in other countries and in States other than New York)School NameStaff NameOther Name Known BySignatureDatePosition? Educational Director? Administrative Director? Coordinator ? Lead/Head Teacher (3-5s only)? Teacher Assistant/Teacher Aide (3-5s only)Educational Background:For Support Staff/Teacher Assistants & Aides: include highest education level completed.For Professional Staff: If degree is not final, attach all transcripts of college courses completed by individual staff member.InstitutionFrom(date)To(date)Major Field of StudyCredit HoursDegrees or Diplomas (Type & Subject Area)Teaching Certifications (In State & Out-of-State): attach a copy of the most recent teaching certificateIf other than permanent certification in Early Childhood Education, a completed Study Plan must also be submitted (page 5).Certification TitleStateDate IssuedInitialCert. (?)Permanent Cert. (?)Teaching Experience with Children Under Age Six (6): include current positionAge GroupsFrom (date)To (date)Name of EmployerPosition HeldStaff Study PlanRevised 11/2017To be completed for any Lead/Head Teacher not professionally/permanently certified in Early Childhood Education (B-2)Voluntary Registration of Nonpublic Nursery Schools and KindergartensSchool NameStaff Name (Lead/Head Teacher of 3-5-year-olds)Age(s) Currently TeachingOverall Education & Employment Goal(s)Areas of InterestAreas in Need of ImprovementContinuing Education Plan to Address Areas Identified Above:TopicSource of TrainingProjected Time FrameCertificationsI verify that the above information represents my intentions to improve my professional expertise and/or obtain professional/permanent teaching certification.Staff Signature ______________________________________Date ____________________I verify that I have reviewed and approved this study plan and will submit updates yearly with the Annual Report.Ed. Director Signature ________________________________Date _____________________SED USE ONLYREVIEWER COMMENTSDATEREVIEWER COMMENTSDATESignificant ChangesPlease describe only significant changes in the areas listed below (information in parenthesis are examples only)School NameSTAFFING PATTERN (e.g. new hires, separations, reassignments, promotions)EDUCATIONAL PROGRAM (e.g. changes to daily schedule, curriculum and/or assessment)HEALTH POLICIES (e.g. administration of medication and staff training)EMERGENCY PROCEDURES (procedures for responding to illness, accident, fire, emergency evacuation, sheltering in place)CLASS ENVIRONMENT (e.g. furniture and equipment, arrangement of space, development of learning centers)Significant ChangesPlease describe only significant changes in the areas listed below (information in parenthesis are examples only)School NameHOURS OF OPERATION (e.g. length and frequency of each session; arrival and dismissal procedures)STUDENT ENROLLMENT (e.g. ages and grades served and number of children in each group/session)NUTRITION POLICIES (e.g. county health inspection, meal patterns, menus and food service, catered meals)FAMILY PARTNERSHIPS (e.g. comprehensive plan to engage families in the education of their children)The University of the State of New YorkVOLUNTARY REGISTERED NONPUBLICTHE STATE EDUCATION DEPARTMENT NURSERY SCHOOLS & KINDERGARTENS Office of Early Learning89 Washington Avenue, Room 319 EBAlbany, New York 12234Site Construction/Renovation ProjectsRevised 03/2018The Office of Early Learning is responsible for collecting and reviewing planned and completed construction/renovation projects made by registered nursery schools and kindergartens. Therefore, each site must complete and sign this form. In addition, photos of any completed projects must be submitted along with this form. This form and accompanying photos must be submitted via email to: HYPERLINK "mailto:oel@" oel@ or by mail to:NYS Education Department, Office of Early Learning, 89 Washington Avenue, Room 319 EB, Albany, NY 12234.Site NamePhone #AddressCity & ZipIs the nursery/kindergarten site planning any indoor or outdoor construction, renovations, or changes to structures, surfaces, equipment, borders or fencing? ? YES (complete the form on page 9)? NOPlease note that all registered nursery/kindergarten sites are required to complete and submit the CRP-1 form on the next page for any planned construction/renovation projects and receive approval from the department prior to work commencing.Has the nursery/kindergarten site completed any indoor or outdoor construction, renovations, or changes to structures/surfaces/ equipment/borders or fencing since 2017? ? YES (provide description(s) below)? NOINDOOR COMPLETED PROJECT DESCRIPTIONDATE COMPLETEDOUTDOOR COMPLETED PROJECT DESCRIPTIONDATE COMPLETEDBy signing below, I am confirming that I have provided complete up-to-date information pertaining to nursery school site construction/renovations and confirm that photos of the completed project(s) will be provided to the Office of Early Learning. Name (Print) ____________________________________________Title _________________________________________ Signature _______________________________________________Date ________________________________________Nursery School/ Kindergarten Authorized SignatureThe University of the State of New YorkVOLUNTARY REGISTERED NONPUBLIC THE STATE EDUCATION DEPARTMENT NURSERY SCHOOLS & KINDERGARTENS Office of Early Learning89 Washington Avenue, Room 319 EBAlbany, New York 12234Site Construction/Renovation PlansCRP-1Revised 03/2018All NYS registered nursery schools and kindergartens are required to disclose any planned indoor & outdoor construction or major renovation to the site. As stated in the Commissioner’s Regulations, Part 125.2 (f): “There shall be no construction, addition, substantial modification or change in occupancy of buildings or parts of buildings used or to be used in the operation of a school unless plans and designs of changes have been approved in writing by the department.”Therefore, any planned changes to the nursery or kindergarten site must be reported below and submitted to our office via email to: oel@ or by fax to: (518) 473-7737 to the attention of Karen McMahon. Attach additional sheets as needed.After the receipt and review of this form, you will be notified of the status or if additional information is needed.Site NamePhone #AddressCity & ZipDESCRIPTION OF INDOOR CONSTRUCTION/RENOVATION PLANSExpected Completion DateDESCRIPTION OF OUTDOOR CONSTRUCTION/RENOVATION PLANSExpected Completion DateBy signing below, I am confirming that I have provided complete information pertaining to the upcoming project(s) to the nursery school site and confirm that photos of the project(s) will be submitted to the Office of Early Learning upon completion. Name (Print) ____________________________________________Title _________________________________________ Signature _______________________________________________Date ________________________________________Nursery School/ Kindergarten Authorized SignatureSED USE ONLYREVIEWER COMMENTSAPPROVED DATEAnnual Report ChecklistListed below are the required documents for a complete report. Use this checklist to ensure that your report is complete and in compliance with the instructions before submitting.Required DocumentsChecked byRegistered SchoolChecked by SED OELReport Cover Page (complete and sign – two signatures)? Included?Fire Safety Report/Fire Safety Inspection Document (attach to Annual Report)? Included?Contact Information Form - page 2 (complete)? Included?School Operation & Enrollment - page 3 (complete)? Included?Staff Background Form - page 4 (complete for new staff, promotions, reassignments) ? Included? N/A?Staff Study Plan - page 5 (complete for lead teachers not permanently certified in EC)? Included? N/A?Significant Changes - pages 6-7 (complete for any subject areas marked on pg. 3)? Included? N/A?Site Construction/Renovation Projects - page 8 (complete & sign)? Included?Photos of Completed Construction/Renovation Projects (for projects described on pg. 8)? Included? N/A?Site Construction/Renovation Plans - page 9 (complete if applicable)? Included? N/A?Submit the completed Annual Report, Fire Safety Report and other supporting documents to oel@ or mail to: New York State Education Department Office of Early Learning89 Washington Avenue, Room 319 EB Albany, New York 12234Attn: 18-19 NSK Annual ReportAfter your report has been reviewed, you will be notified by e-mail if any additional information is needed. ................
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