AFFIRMATION OF CONSULTATION WITH PRIVATE (NON …



Supplemental page - use to list multiple non-public schools requiring one authorized non-public representative to sign-offUpload to eGrants with original signed Affirmation of Consultation *AFFIRMATION OF CONSULTATION WITH PRIVATE (NON-PUBLIC) SCHOOL OFFICIALSThe goal of reaching agreement between an LEA and appropriate private school officials is grounded in timely, meaningful, and open communication between the LEA and the private school officials on key issues that are relevant to the equitable participation of eligible private school students, teachers and other education personnel, and families in ESEA programs.LEA InformationName of LEA:Name of Superintendent/LEA Authorized Representative:Telephone Number:Email Address:Private (Non-public) School InformationName of Private (Non-public) School:Private (Non-public) School Authorized Representative:Telephone Number:Email Address:PRIVATE (Non-public) SCHOOL NAMElist for each school belowPARTICIPATION BY TITLE PROGRAM (Check off to indicate nonpublicschool program participation as applicable)SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?SCHOOL NAME:Title I A ?Title II A ?Title III ?Title IV ?0271618Private (Non-public) School Authorized Representative SignatureDate* Required upload only if form is complete ................
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