This is a worksheet. Use only in preparation for data entry over the Internet. Do not send to NJDOE .
NONPUBLIC SCHOOL ENROLLMENT REPORT
WORKSHEET
SECTION A
SCHOOL INFORMATION
1.
School Codes (Pre-coded – not visible on page)
County
District
School
2.
Name And Address of School And Contact Information This information will be
pre-coded. Record any changes to this information in Question #3, below.
County
Public School District in which nonpublic school is located:
Nonpublic School Name
Physical Address of Nonpublic School
Address1:
Address2:
City:
State: New Jersey
Zip
Mailing Address of Nonpublic School (if different from physical address above)
Address1
Address2
City
State: New Jersey
Zip
Telephone:
3.
Record Below Corrections Or Additions To The Information On Our Current
Nonpublic School File Displayed Above.
New Physical Address Information
County
Public School District in which nonpublic school is located
Nonpublic School Name
Physical Address of Nonpublic School
Address1
Address2
City:
State: New Jersey
Zip
Telephone
New Mailing Address Information
Address1
Address2
City
State: New Jersey
1
Zip
This is a worksheet. Use only in preparation for data entry over the Internet. Do not send to NJDOE .
4.
Name of Principal/Director
First Name:
Last Name:
5.
Primary Contact E-Mail Address:
School’s Fax:
6.
Type of Nonpublic School. The type checked below is based upon information on
file for your school in the department. If your school has changed type, select the
correct type from the list.
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
__
__
__
__
__
__
__
__
__
__
__
Private School For Students With Disabilities - Elementary/Secondary
Private School For Students With Disabilities - Secondary
Private School For Students With Disabilities - Elementary
Kindergarten
Elementary School
Middle School
Junior High School
4 Year High School
6 Year High School
3 Year High School
Combined Elementary/Secondary School
Nonpublic schools of type a, b or c will proceed to Section B; those of type d
through k will skip to Section C.
7. Would you like to receive school security alerts? ____ Yes ____No
2
This is a worksheet. Use only in preparation for data entry over the Internet. Do not send to NJDOE .
SECTION B
ENROLLMENT INFORMATION
PRIVATE SCHOOLS FOR STUDENTS WITH DISABILITIES
8.
Total Special Education Enrollment (all grades and ungraded) as October
15th:
New Jersey
Resident
9.
Non New Jersey
Resident
(Auto) Total
Tuition:
a) Does your school enroll students whose tuition is paid by their school district?
___
Yes - Number of enrolled New Jersey residents: __________
___
No
b) Does your school enroll students whose tuition is paid by their parents?
___
Yes - Number of enrolled New Jersey residents: __________
Note: The number of enrolled New Jersey residents in this question (9b) pertains to those students whose
tuition is paid by their parents/guardians.
In questions 11-13 in Section D (New Jersey Enrollment Aged 5-17), answer these enrollment questions as
they pertain to the students whose tuition is paid by their parents/guardians only. The counts should not
exceed the number of enrolled New Jersey residents entered in 9b above.
___
No
3
This is a worksheet. Use only in preparation for data entry over the Internet. Do not send to NJDOE .
SECTION C
ENROLLMENT INFORMATION
REGULAR NONPUBLIC SCHOOLS ONLY
(Private Schools for the Disabled should not complete this page.)
10.
Enrollment By Residency Status, as of October 15th:
Col. 1
Col. 2
Line
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
m)
n)
Grade 12
Total
Col. 3
New Jersey
Resident
4
Col. 4
Non New Jersey
Resident
Col. 5
(Auto) Total
This is a worksheet. Use only in preparation for data entry over the Internet. Do not send to NJDOE .
SECTION D
STATE AND FEDERAL PROGRAMS
11.
Count of New Jersey Resident Enrollment Aged 5-17 as of October 15th:
_______
12.
Total number of students eligible for free meals/free milk:
_______
13
Total number of students eligible for free meals/free milk Aged 5-17:
_______
14.
Does your school offer free meals to students? ___ Yes
15.
Number of students who are Limited English Proficient (LEP):
16.
17.
___ No
Do you want to be considered eligible for the following programs? Only
those school responding ‘Yes’ will be eligible to receive textbook aid,
technology and nursing services. Schools that have applied previously or
received an entitlement in prior years must reapply.
__ Yes
___ No
State Nonpublic Textbook Aid
__ Yes
___ No
State Nonpublic Technology
__ Yes
___ No
State Nonpublic Nursing Services
__ Yes
___ No
Federal Grant Programs1
Are you a non-profit nonpublic school? If ‘Yes,’ please enter the New Jersey
State Tax Exemption Certificate Number qualifying you for nonprofit status.
___ Yes
Tax Number
__ No
___________________________
Thank you!
Do not mail or fax this form. Use it only as a worksheet.
1
_______
Only non-profit nonpublic schools are eligible for these federal programs.
5