SPECIAL EDUCATION DOCUMENTATION SHEET

Documentation for Special Education Services

ILLINOIS STATE BOARD OF EDUCATION Funding and Disbursements 100 North First Street

Springfield, Illinois 62777-0001

SPECIAL EDUCATION DOCUMENTATION SHEET (Sections 14-7.02b and 14-7.03 of the School Code)

_________________________ through _________________________

SCHEDULE A - PERSONNEL DOCUMENTATION FOR CURRENT YEAR EXPENSES IN CALCULATING PER CAPITA COST

IEIN

Name

(1)

(2)

Code (3)

Work Assignment

(4)

Allocation Ratio

(5)

Total Salary (6)

Salary Allocation

(7)

CURRENT YEAR

Evidence Based Funding Personnel

(8)

Evidence Based Funding Personnel Allocation

(9)

FEDERAL FUNDS CURRENT YEAR

Total Federal IDEA Part B

Funds

(10)

Total Federal IDEA Part B Allocation

(11)

OTHER SALARY CURRENT YEAR

Other State or Federal Salary

(12)

Other State or Federal Salary

Allocation

(13)

ISBE 50-66BL (4/18)

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