F-3 - New York City



-2159005842000NEW YORK CITY ADMINISTRATION FOR CHILDREN’S SERVICESDIVISION OF EARLY CARE AND EDUCATIONPARENT ADVISORY COMMITTEE (PAC)ELECTION FORMTABLE OF CONTENTSF3New York City Administration for Children’s ServicesDivision of Early Care and EducationClassroom Election Attendance SheetF4New York City Administration for Children’s ServicesDivision of Early Care and EducationClassroom Committee Representatives FormPARENT ADVISORYCOMMITTEE(PAC) ELECTIONCERTIFICATION FORMF13New York City Adminstration for Children’s ServicesDivision of Early Care and EducationParent Advisory Committee Report FormF-3New York City Administration for Children’s Services2921008636000Division of Early Care and EducationClassroom Election Attendance SheetProgram Name: _____________________________ Date __________Program Address____________________________ Telephone _____________State the number of children enrolled in this class at the time of classroom election ________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 fileType of Election:[ ] Open Vote Meeting [ ] Closed Ballot Meeting [ ] All Day Voting (Ballot Box)1194435150495COMPLETE ONE FORM PER CLASSROOM00COMPLETE ONE FORM PER CLASSROOMParent Election Coordinator _________________________ Telephone ____________Email ________________________________ FAX Number_____________Name (please print)SignatureClassroom Child’s NameF-4New York City Administration for Children’s Services20320016256000Division of Early Care and EducationClassroom Committee Representatives FormAgency Date: ____________Agency Address ________________________________ # Classrooms: ____Name of Class: ____________# Enrolled: ___ Teacher: __________ 177165064770COMPLETE ONE FORM PER CLASS SESSION00COMPLETE ONE FORM PER CLASS SESSIONChairperson’s Name _______________________________Child’s Name______________Position: _______________Telephone: __________________Home Mailing Address: _____________________________________________ Apt. #Zip CodeEmail Address: _______________________________________Co-Chairperson’s Name _______________________________Child’s Name___________Position: ____________________Telephone: ________________Home Mailing Address: ____________________________________Apt. #Zip CodeEmail Address: _____________________________________Secretary’s Name _______________________________Child’s Name________________Position: ____________________Telephone: ________________Home Mailing Address: ____________________________________________Apt. #Zip CodeEmail Address: __________________________________________Alternate’s Name____________________________________ Child’s Name___________Position: ____________________Telephone: ________________Home Mailing Address: ________________________________________________Apt. #Zip CodeEmail Address: _______________________________________Alternate’s Name____________________________________ Child’s Name___________Position: ____________________Telephone: ________________Home Mailing Address: _______________________________________________Apt. #Zip Code-8001009258300Parent Election Coordinator Name_____________ E-Mail__________________ Tel____________00Parent Election Coordinator Name_____________ E-Mail__________________ Tel____________Email Address: ______________________________________________-50806985000THE CITY OF NEW YORKNYC ADMINISTRATION FOR CHILDREN’S SERVICESDIVISION OF EARLY CARE AND EDUCATIONDIVISION OF PROGRAM DEVELOPMENTPARENT ADVISORYCOMMITTEE(PAC) ELECTIONCERTIFICATION FORMPROGRAM NAME:FISCAL NO.BOARD NAME:ADDRESS:ADDRESS:BORO: ZIP CODE:BORO: 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)I HEREBY CERTIFY THAT THE ELECTION REPORTED HEREIN WAS PROPERLY 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 PROCESSNO. 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:RECORDING SECRETARY:EMAIL:TREASURER:EMAIL:NOTES:BALLOTING CAN BE DONE DURING THE HOURS OF OPERATION ( 8:00 A.M. TO 6:00 P.M.) or AT A PAC MEETING IF HELD ON THE SAME DAY AS BALLOTING.A QUORUM OF PARENTS MUST BE AT THE MEETING WHEN THE ELECTION IS HELD.A QUORUM = 50 % PLUS (+) ONE (1) OF ALL PARENTS ENROLLED IN THE PROGRAM.PAC ELECTIONS MUST BE CONDUCTED BY October 14, 2016.PLEASE SUBMIT ALL PARENT ELECTION FORMS VIA: EMAIL ADDRESS:HSDAPC@ACS.ORFAX NUMBER:917 551-7295F-132540022923500New York City Adminstration for Children’s ServicesDivision of Early Care and EducationParent Advisory Committee Report FormAgency ____________________________Site Address________________Child Care Director_____________________________Telephone: __________Election Coordinator__________________ E-Mail________________ Telephone____________Date__________________Results:ConductedNot ConductedCheck Item(s) Reviewed:Election Minutes Class Minutes PAC Orientation Number of Classroom ___ Number of Representatives per Classroom ___Number of Community Representatives Members ___Total number of representatives to the PAC Committee: ____Mode of Electionby Paper BallotSpecial MeetingWas There A Quorum?Yes No If Not, Why? Were All Motions Seconded?Yes No Officers:Chairperson ______________________________Telephone_______________Address __________________________________Email___________________Vice Chairperson__________________________ Telephone: ____________Address __________________________________Email___________________Secretary: ______________________________________________________Treasurer: ______________________________________________________Personnel Practices Committee: _____________________________________Grievance Committee: __________________________________________________Education/Program Committee: ___________________________________________Bylaws Committee: Special Activities Committee: _______________________________________________________________________________________ ______________ACS Monitor Signature Date Monitor Date Self MonitoredChild Care Director ____________________________________ Date _____________15373353431540001423035434594000153733517170400016605255375275 Committee Chairs:Chairperson (President) Bylaws CommitteeVice Chairperson (Vice-President) Grievance CommitteeTreasurer (Finance Comm. Chair) Education/Program CommitteeSecretary Personnel Practices Committee Special Activities Committee00 Committee Chairs:Chairperson (President) Bylaws CommitteeVice Chairperson (Vice-President) Grievance CommitteeTreasurer (Finance Comm. Chair) Education/Program CommitteeSecretary Personnel Practices Committee Special Activities Committee1765935802640Division 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-365760548640002540015240100Appendix D Administration for Children’s Services Child Care Programs OnlyParent Elections Timetable Conduct Parent Orientations by 9-9-2016 Complete Classroom Elections by 9-23-2016 Conduct PAC Election by 10-14-2016REQUIRED ELECTION DOCUMENTATION F3 Classroom Election Attendance Sheet 10-7-2016 F4 Classroom Committee Representative Form 10-7-2016 F13 Parent Advisory Committee Report Form 10-14-2016 Certification Forms due to ACS by 10-28-2016 FAX – 917 551-7295Email / Scan – HSDAPC@acs. ................
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