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DALLAS COUNTY SCHOOL SYSTEM FEDERAL PROGRAMS DEPARTMENTTITLE-I Monthly Checklists & Documentation FormsDR. VICIE S. LARKIN FEDERAL PROGRAMS DIRECTORMRS. FAYE S. BONNER FEDERAL PROGRAMS BOOKKEEPERMRS. NANCY T. WALKER FEDERAL PROGRAMS SECRETARYAugust 2010 TABLE OF CONTENTS. Monthly Checklist. Title-I Schoolwide Plan Checklist. Title-I Schoolwide Professional Development Documentation Form. Title-I Grade Level/Department Professional Development Documentation Form. Title-I School Department Planning Form. Title-I Review At-A-Glance Form. Dallas County Schools Proposal for Professional Development. Request for Out of County Travel. Federal Programs Mid-Year Review. Title-I School Transition Activity Schedule Form. Federal Programs Class Size End of Year Enrollment Form. Title-I Inventory Form. 2010-2011 School Personnel Listing. Schoolwide Template Companion Document. LEA Title-I Plan (Keep the 2009-2010 Plan until you receive your Title-I approval form) . Federal Programs End of the Year Summary Report. Time Record for Multi-Funded Employees. Time Sheet Dallas County Schools Title-I Calendar 2010-2011Month: July Due: August 13, 2010*** Complete a school inventory form each month if equipment has been ordered.***____ Attend Title-I Principals’ meeting ____ Administer AHSGE July 12-16, 2010____ Review procedures for enrolling homeless students with secretary and/or personnel enrolling students ____ Complete form verifying members of school planning committee. (High Schools include students and send to CO on Aug. 13) ____ Schoolwide Committee form Principal’s Signature______Date______Send to Nancy Walker on or before the due date. Dallas County Schools Title-I Calendar 2010-2011Month: August Due: August 27, 2010*** Complete a school inventory form each month if equipment has been ordered.***______Complete school budget form with signatures of teachers, parents, and high school students ______Send a copy of master schedules due 8/27*______File School Personnel list received from Mr. Willingham with funding source ______Complete form verifying grade level or departmental meetings were held ______Complete comprehensive needs assessment using attendance, discipline, professional development, Stanford-10, ARMT, Classworks, DIBELS, AHSGE, documentation of instructional strategies based on disaggregated data and parental involvement needs ______Complete the following: (1) Comprehensive needs assessment (2) Schoolwide reform strategies (3) HQT (4) Professional Development ______Review Schoolwide Plan SDE Approval form for Components 1-5 ______Conduct Title-I Parent Meeting to share FY10 test results (Separate from PTO or Open House Meetings)______Develop Intervention Plan based on the needs assessment ______Conduct school planning meeting with parental involvement. File written evidence ______Administer DIBELS Assessment August 23-September 3, 2010______Complete Time/Effort Sheets of T-I funded teachers/tutors and turn in to the Central Office with payroll ______Distribute parents’ right to know letter to parents when received from central office ______Distribute school compacts to be signed by teachers, student and parents. ______Develop a list of all programs to be purchased with federal funds with descriptions of purpose and objectives to be met with the program due 8/27* AUGUST CONTINUED______Conduct a planning meeting and complete an agenda/minutes showing teachers were involved in T-I decision making concerning student achievement. File written evidence. ______Conduct a meeting informing teachers of the eligibility of homeless children; create and complete a form verifying that the meeting was held with the teachers and the person enrolling students (attach agenda/minutes) due 8/31*Principal’s Signature______Date______Send to Nancy Walker on or before the due date. Dallas County Schools Title-I Calendar 2010-2011Month: September Due: September 30, 2010***Complete a school inventory form each month if equipment has been ordered.***_____ Conduct a grade level or departmental meetings with documentation (discuss students progress) File written evidence _____ Administer Classworks assessments; send completed data to the Central Office, due Oct. 5, 2010 _____ Administer AHSGE September 20-24, 2010_____ Create a form verifying that teachers/parents received a copy of the Schoolwide plan due Oct. 5, 2010 _____ Review Component 6-10: Due: Sept. 17, 2010 (6) Parental Involvement (7) Plans for transition (8) Evidence of teachers involved in decision-making process (9) Timely assistance to students experiencing difficulty (10) Coordination and integration of federal, state, and local services and programs _____ Review Schoolwide Plan SDE Approval form for Components 6-10 _____ Hold monthly Parental Involvement sessions (attach agenda/minutes) _____ Attend monthly T-I Principals’ Meeting _____ Principal conducts observation to assure programs are being implemented _____ Complete Time/Effort Sheets T-I funded teachers/tutors and turn in to the Central Office with payroll _____ Complete form verifying monthly schoolwide professional development was held (attach agenda/minutes and sign-in sheets) due 9/30Principal’s Signature______Date______Send to Nancy Walker on or before the due date. Dallas County Schools Title-I Calendar 2010-2011Month: October Due: October 29, 2010***Complete a school inventory form each month if equipment has been ordered.***_____ Conduct grade level or departmental meetings with documentation (discuss students progress) _____ Conduct principal observation to assure programs are being implemented. File written evidence _____ Complete a form verifying monthly schoolwide professional development was held (attach agenda/minutes and sign-in sheets) _____ Attend monthly T-I Principals’ Meeting _____ Complete Time/Effort Sheets of T-I funded teachers/tutors and turn in to the Central Office with payroll _____ Hold monthly Parental Involvement sessions (attach agenda/minutes) _____ Review Classworks and AHSGE results and plan intervention for targeted students _____ Review Schoolwide Plan with teachers and select parents. File written evidence Principal’s Signature______Date______Send to Nancy Walker on or before the due date. Dallas County Schools Title-I Calendar 2010-2011Month: November Due: November 19, 2010***Complete a school inventory form each month if equipment has been ordered.***_____ Conduct grade level or departmental meetings with documentation (discuss students progress) _____ Hold monthly parental involvement sessions (attach agenda/minutes) _____ Conduct principal’s observation to assure programs are being implemented. File written evidence. _____ Complete Time/Effort Sheets of T-I funded teachers/tutors and turn in to the Central Office with payroll _____ Attend monthly T-I Principals’ Meeting _____ Complete form verifying monthly Schoolwide professional development was held (attach agenda/minutes and sign-in sheets)Principal’s Signature______Date______Send to Nancy Walker on or before the due date. Dallas County Schools Title-I Calendar 2010-2011Month: December Due: December 17, 2010***Complete a school inventory form each month if equipment has been ordered.***_____ Conduct grade level or departmental meetings with written documentation (discuss students progress) _____ Administer DIBELS assessment December 6-17, 2010_____ Administer Classworks Benchmark assessments; send completed data to the Central Office Jan. 7. 2011._____ Administer AHSGE December 6-10, 2010_____ Hold monthly parental involvement sessions (attach agenda/minutes) _____ Principal observes classrooms with written evidence to assure programs are being implemented _____ Complete Time/Effort Sheets of T-I funded teachers/tutors and turn in to the Central Office with payroll _____ Attend monthly T-I Principals’ Meeting _____ Complete form verifying monthly Schoolwide professional development was held (attach agenda/minutes) Principal’s Signature______Date______Send to Nancy Walker on or before the due date. Dallas County Schools Title-I Calendar 2010-2011Month: January Due: January 29, 2011***Complete a school inventory form each month if equipment has been ordered.***_____ Conduct grade level or departmental meetings with written documentation (discuss students progress) _____ Hold monthly Parental Involvement sessions (attach agenda/minutes) _____ Principal observes classrooms with written evidence to assure programs are being implemented _____ Complete Time/Effort Sheets of T-I funded teachers/tutors and turn in to the Central Office with payroll _____ Prepare for Mid-Year Review by Federal Program Coordinator_____ Complete form verifying monthly Schoolwide professional development was held (attach agenda/minutes) _____ Attend monthly T-I Principals’ Meeting Principal’s Signature______Date______Send to Nancy Walker on or before the due date. Dallas County Schools Title I Calendar 2010-2011Month: February Due: February 26, 2011***Complete a school inventory form each month if equipment has been ordered.***______Conduct grade level or departmental meetings with written documentation (discuss students progress)______Hold monthly parental involvement sessions (attach agenda/minutes) ______Principals observe classrooms with written evidence to assure programs are being implemented ______Complete Time/Effort Sheets of T-I funded teachers/tutors and turn in to the Central Office with payroll ______Administer AHSGE February 28, 2011______Administer Classworks Benchmark assessments; send completed data to the Central Office ______Complete form verifying monthly Schoolwide professional development was held (attach agenda/minutes) ______Attend monthly T-I Principals’ Meeting ______K-6 administer Scott Foresman Benchmark #3 Unit Assessment – See Mrs. Carrington Principal’s Signature______Date______Send to Nancy Walker on or before the due date Dallas County Schools Title I Calendar 2010-2011Month: March Due: March 31, 2011***Complete a school inventory form each month if equipment has been ordered.***______Conduct grade level or departmental meetings with written documental (discuss students progress) ______Hold monthly parental involvement sessions (attach agenda/minutes) ______Principals observe classrooms with written evidence to assure programs are being implemented ______Complete Time/Effort Sheets of T-I funded teachers/tutors and turn in to the Central Office with payroll ______Complete form verifying monthly professional development was held (attach agenda/minutes)______Attend monthly T-I Principals’ Meeting______Administer AHSGE March 1-5, 2011______Begin analyzing data and programs to complete end of year summary Principal’s Signature______Date______Send to Nancy Walker on or before the due date Dallas County Schools Title I Calendar 2010-2011Month: April Due: April 20, 2011***Complete a school inventory form each month if equipment has been ordered.***______Conduct grade level or departmental meetings with written documental (discuss students progress) ______Hold monthly parental involvement sessions (attach agenda/minutes) ______Principals observe classrooms with written evidence to assure programs are being implemented ______Administer DIBELS assessment (K-2) April 18 – April 29, 2011______Complete Time/Effort Sheets of T-I funded teachers/tutors and turn in to the Central Office with payroll ______File school site visit forms from Federal Program Coordinator______Complete End of Year Summary ______Attend monthly T-I Principals’ Meeting ______Plan and schedule school transition activities for students and parents entering and leaving school site Principal’s Signature______Date______Send to Nancy Walker on or before the due date Dallas County Schools Title I Calendar 2010-2011Month: May Due: May 20, 2011***Complete a school inventory form each month if equipment has been ordered.***______Conduct grade level or departmental meetings with written documental (discuss students progress) ______Hold monthly parental involvement sessions (attach agenda/minutes) ______File evidence of school transition activities for entering and leaving students and parents ______Principal observes classrooms with written evidence to assure programs are being implemented ______Complete Time/Effort Sheets of T-I funded teachers/tutors and turn in to the Central Office with payroll ______File school site visit forms from Federal Program Coordinator______Attend monthly T-I Principals’ meeting ______Copy of all school budgets with teachers signature ______Complete end of year class size attendance form (See Nancy Walker for copy of form)Principal’s Signature______Date______Send to Nancy Walker on or before the due date Dallas County Schools Title I Calendar 2010-2011Month: June Due: Last Working Day on Duty***Complete a school inventory form each month if equipment has been ordered.***______Meet with Federal Programs Coordinator to discuss plans and budgets for 2010-2011______If applicable, complete professional development forms to request Title I funds and approval for summer professional development activities held at your school site. ______If applicable, complete and submit a proposal to conduct a Title I funded summer tutoring program to be held at your school site.______If applicable, complete summer payroll (2nd Friday of each month) Principal’s Signature______Date______Send to Nancy Walker on or before the due date Dallas County Schools Title-I Schoolwide Program Plan Review and Approval Form 2010-2011SCHOOL:______The following items have been reviewed and approved in your plan:Yes No Complete Comprehensive Needs Assessment (Component 1) Yes No Complete Schoolwide reform strategies (SIP) (Component 2)Yes No Complete Instruction by Highly Qualified Teacher (Component 3) Yes No Complete Professional Development Plan (Component 4) Yes No Complete Strategies to Attract Highly Qualified Teachers (Component 5) Yes No Complete Parental Involvement Plan (Component 6) Yes No Complete School Transition (Component 7) Yes No Complete Teacher Involvement in Academic Assessment (Component 8) Yes No Complete Timely Assistance to Students (Component 9) Yes No Complete Coordination of Integration of Funds (Component 10) Yes No Complete Program Overview if not in School reform strategies Yes No Complete Schoolwide Checklist Template w/ page numbersItems to Be Checked at the Middle and End of the Year_____ T-I SW/TA Plan Approval _____ Mid-Year Review _____ End of Year SummaryFederal Programs Coordinator Signature DatePrincipal’s Signature Date Dallas County School System FY2010-2011 Title I Schoolwide Professional Development Documentation FormSchool Date Presenter/Consultant Topic of Session:Identified Needs:Teacher’s Present ______Principal’s Signature______Dallas County Schools FY2010-2011 Title I Grade Level/Development Professional Development Documentation FormSchool______Date______Grade Level/Department______Presenter/Consultant______Topic of Session:Identified Needs:Teacher’s Present ______Principal’s Signature______Dallas County Schools Title I School Department Planning Form 2010-2011Department Needs Assessment: 1. 2. 3. 4. Assigned Chairperson by Principal: ______Department Chairperson by Peers: ______Identified Needs: ______(Greatest Need) ______(Plan of Action) ______(Professional Development) ______BE SPECIFIC Population of greatest student needs/ students who failed the HSGE stanine 1-4Activities to improve students/students who failed the HSGE stanine 5-9Follow up review Department PlansDallas County Schools Title I Review At A Glance 2010-2011School______Enrollment______% in Poverty______Allocation______Parental Involvement Allocation______Summary Needs Professional Development Focus ______Targeted Areas Extended Day Learning Focus ______Programs Implementing This Year Summer Focus ______Title I Paid Personnel: Parental Involvement Goals ______Principal’s Signature______Federal Program Coordinator’s Signature______Dallas County Schools Proposal for Professional DevelopmentName Date of Request School Position Type of Event: ( ) Workshop ( ) Other-Specify Date(s) of Events Location Purpose of Event:Strategies addressed in School Plans:Benefits to students:Proposed Expenses$ Food $ Registration $ Lodging $ Substitute $ Transportation $ Teacher Stipend $ Other Teacher Signature______Date______Approved by Principal______Rejected______Approved by Fed. Pro. Coor.______Rejected______Approved by Prof. Dev. Coor.______Rejected______Approved by Superintendent______Rejected______Please attach a copy of any brochure or agenda. A copy of this approved form must be submitted when request for reimbursement is submitted.For Central Office Use Only Funding Source: State Title I CO Title I School Title II Sp. Ed. Title V Title VI B Other:______Account Codes______White: Person making request/to return to Central Office w/original receipt & reimbursement form for reimbursement Yellow: Professional Development Secretary Pink: Payroll Gold: School Dallas County SchoolsREQUEST FOR OUT OF COUNTY TRAVELName Date of Request Position Date of Trip Location of Trip Purpose of Trip Type of Expense Requested (Check those that apply)Food Motel or HotelMileage Other – List Approved RejectedComments:Superintendent Dallas County Schools Dallas County Schools Federal Programs Mid-Year ReviewSchool______Date______Title I Schoolwide______FEDERAL DOLLARS ASSIGNED TO THIS SCHOOL SITET-I_____ T-II______SR______SRD______T-V_____T-VI-B______Reading First______Homeless______LEP______PROGRAMS PURCHASED WITH FEDERAL FUNDSVoyager______Lightspan______I Care______Compass______A+______Houghton Mifflin Support Materials______I Can Learn_____ Plato_____ Other Specify____ ****************************************************************************** Is there evidence that each component of the T-I Schoolwide plan is being implemented:1. Needs Assessment (process used, data sources, prioritized needs) ______2. Schoolwide Reform Strategies (extended learning, strategies for subgroup, progress monitoring) ______3. Instruction by HQT ______4. High Quality Ongoing Professional Development (documentation relevant to needs assessment, reform strategies, instructional program/practices) ______5. Increased Parental Involvement (School parent Plan, Documentation of Activities) ______6. Plans for smooth transition (documentation of activities, meetings, notes, agendas) ______7. Teacher involvement in decision making ______8. Documentation of monitoring students’ progress/intervention (additional assistance provided) ______9. Evidence of Parental and Community involvement in school wide planning ______10. Evidence that school staff and parents are familiar with plan ______11. Does the principal have a clear understanding of the T-I Schoolwide program? ______12. Are the teachers aware of the needs of students to effectively implement strategies of the T-I plan? ______Principal’s Signature______FPC Signature______Dallas County Schools 2010-2011 Title I School Transition Activity Schedule FormPrincipals:Please list the data of your annual school transition activity to assure a smooth transition from the ending grade in each school to the beginning grade in next school (Section 1114b (1) (G)Activities for students entering your school siteDate______Time______Place______Activities for students leaving your school siteDate______Time______Place______Principal’s Signature______(Please send a copy of program activities to Central Office after activity takes place.) May 2011 Dallas County Schools Federal Programs Class Size End of Year Enrollment Form (These numbers should match your end of year attendance data)School______Number of Ending Number Grade Teachers Enrollment Retained K 1 2 3 4 5 6 7 8 9 10 11 12Principal’s Signature______DALLAS COUNTY SCHOOL SYSTEM FEDERAL PROGRAMS DEPARTMENT 429 LAUDERDALE STREET SELMA, ALABAMA 36701Title-I Inventory ListDate: ______School:______ITEM DESCRIPTION SERIAL NO. LOCATION/ROOM FUNDS YEARSignature______School Personnel Listing for 2009-2010 REVISED 04-07-10 School Site Name Position Funding % Funded Source Brantley (Schoolwide) Latoya Tolbert Teacher Title I , FP 87%, 13% Pat Vlack Teacher Title I, FP 24%, 76% Rose Smith Reading Intervention ARRA-TI, FP 28%, 72% Audrey Strong Reading Coach ARI 100%Bruce K. Craig (Schoolwide) Jennifer Hall Art Literacy Teacher Title I, FP 38%, 62% Shanetta Holman Reading Coach ARI 100% Barbara Cowan Reading Lab Title I 100% Jessie Sharpe Aide Title I 100%Five Points (Schoolwide) Mia Fails Teacher Title II, FP 75%, 25% Clifton Reeves Teacher Title I, FP 54%, 46% Dyphelia Thrash Reading Coach ARI 100%Salem (Schoolwide) Eldrick Collins Teacher Title I, FP 6%, 94% Santaush Cobb Reading Coach ARI 100% Linda Pettway Teacher Title I, ARRA 75%, 25%Southside Primary Patricia Hardy Literacy Lab Title I, FP 91%, 9% (Schoolwide) Allison Kelley Reading Coach ARFI 100% Adrian King Teacher Title I, FP 55%, 45%Shiloh (Schoolwide) Jackie Averhart Reading Coach ARI 100% Felicia Glover Teacher Title II 100% Charity Hobbs Teacher Title-I, 48% ARRA- TI, FP 21%, 31% Yolanda Smith Nickleson Teacher ARRA-TI, FP 65%,35% Southside High Title I, 43%, (Schoolwide) Leroy Miles Computer ARRA-TI 57% Kim Provitt Teacher Title I, FP 62%, 38% Daniel Wiley Teacher Title I, FP 93%, 7%Tipton (Schoolwide) Undre Rush Teacher Title I, FP 15%, 85% Idette Clay Teacher Title I 100%Keith Title I, (Schoolwide) Jack Hudson Teacher ARRA-TI, FP 50%, 43%, 7% Derek Marshall Teacher ARRA-TI, FP 40%, 60% Cynthia Gibson Teacher ARRA-TI, FP 20%, 80% Jonathan Smith Teacher Title I, FP 94%, 6%J. E. Terry Intervention/ (Schoolwide) Bonnie Ellison Computer Title I, FP 12%, 88% Aimee’ Baxter Teacher Title II 100% Donna Holifield Reading Coach ARI 100% Quanitsha D. Sneed Aide Title 100%Valley Grande (Non-Title I) Tracey Perkins Reading Coach ARI 100% Megan Anthony Classworks Aide Title I 100% Rhonda Brown Teacher Title I, FP 52%, 48% Elizabeth Frederick Reading Facilitator Title I 100%Dallas County High (Schoolwide) Willie Moore Admin. Title I 10 Days Jessica Crowe Teacher Title I, FP 40%, 60% Title I, 41% Lanette Gayle Teacher ARRA-TI, FP 24%, 35%Martin Middle (Schoolwide) Kimberly Burnett Teacher Title I, FP 50%, 50% Central Office Vicie S. Larkin Federal Programs Title I 95% Director FP 5% Diane Mohphrasit Prov. Dev., Title I, SPE 50%, 25%, 25% Attendance, Textbks Title II Faye Bonner Federal Programs Title I, Sp. Ed. , 75%, 10%, 15% Bookkeeper FP Nancy T. Walker Federal Programs Title I 100% Secretary Mary Shaw Instructional Staff Title I 50% Secretary Title II 50% Gwen Carrington Reading Coordinator Title I, FP 50%, 50% Elaine Poole Parent Facilitator Title I 100% Dorothy Irvin Parent Facilitator Title I 100% Richard “Niko” Martin Tech. Repairman Rural Ed 100% Rural Ed, CNP, 15%, 29%, Aaron Ellis Tech. Repairman FP, Sp. Ed. 24%, 32% Title II, ARRA, 59%, 13% Terry Grissom Professional Dev. FP 28% Zella Ford PD Coordinator Title II 100% Instructional Felicia K. Thomas Specialist Title I, SIP 77%, 23% Testing Coordinator Vickie Poe Counseling Title I, FP 75%, 25% CIP/Principal Coach/ Title II, SIP, 22%, 68% Patricia Redd PEPE Rural Ed 10% Title V, Title 14%, 62%, Karen Dismukes Gifted Teacher VI, Gifted Ed. 24% Rural Ed 25% Title II 25% David Hagood Media Specialist FP 50% Federal Programs 2010-2011 End of Year Summary ReportDUE ON OR BEFORE April 22, 2011 (This report will be available on the website to down load)Turn in to the Federal Programs Secretary, Mrs. Nancy Walker School Name______End of the Year Summary Reports For Federal Programs1. Based on the assessment tools used to measure student achievement throughout the school year, identify the strengths and weaknesses of your students by subject.K-3 DIBELS/Results 3-8 Classworks/Results 9-12 AHSGE/Results Other ______Name Assessment Instrument______First Second Third Benchmark/Assessment Benchmark/Assessment Benchmark/AssessmentStrengths: Strengths: Strengths:Weaknesses: Weaknesses: Weaknesses: School Name______Name Assessment Instrument______First Second Third Benchmark/Assessment Benchmark/Assessment Benchmark/AssessmentStrengths: Strengths: Strengths:Weaknesses: Weaknesses: Weaknesses: School Name______2. Based on the assessment results identified, summarize in detail your projected academic focus for 2010-2011.2a. List professional development focus for 2010-2011 based on weaknesses identified from test results summary.3. List the programs that you implemented this year with Title I funds. Specify how these programs were used to improve instruction School Name______4. Please check the personnel in your site that are being paid with Title I funds. (Specify the number of personnel in each category)□ Classroom Teacher_____ □ Reading Coach_____ □ Computer Lab Teacher_____ □ I Can Learn Computer Lab Teacher_____ □ Science Lab Teacher_____ □ Part-time Librarian_____ □ After-School Tutors_____ □ Assistant Principal_____ □ Counselor_____ □ Transition Teacher_____ □ Reading Intervention Teacher_____ □ Arts in Literacy Teacher_____ □ Other_____5. If funds are available for the 2010-2011 school year for site to add additional personnel, specify what position and state how this position will be used to meet the overall instructional needs of your Schoolwide program.6. The new law will require that Title I funds be used for scientifically based research programs. What programs are you currently implementing at your school site? (Ex. Read 180, Voyager, I Can Learn, etc.)7. What scientific researched based program would you like to see implemented at your school site for 2010-2011? School Name______8. List total faculty professional development sessions held at your school site during 2010-2011. Include sessions at Technology Lab.DATE SESSION FOCUS PRESENTER9. List total faculty professional development sessions planned for your school site for 2010-2011. Include sessions in the tech lab.DATE SESSION FOCUS PRESENTER School Name______10. Title I Summer Professional Development Agenda School Site Professional Development Activities(Please list the Schoolwide Professional Development activities you have planned for your school site during the summer months. Remember to submit your professional development leave forms for prior approval. If you are planning to have test assessment interpretation and planning sessions to review Stanford-10, AHSGE, ARMT and/or DIBELS results, remember to include on this page.I. Professional Development Dates______Inservice Objectives Number of Teaches That Have Committed To Attend______(Attach listing and signatures of teachers for this event.)Reimbursement Requesting Stipends______Consultant Fee______II. Professional Development Dates______Inservice Objectives Number of Teachers That Have Committed To Attend______(Attach listing and signatures of teachers for this event.)Reimbursement Requesting Stipends______Consultant Fee______III. Professional Development Dates Inservice Objectives Number of Teachers That Have Committed To Attend______(Attach listing and signatures of teachers for this event.)Reimbursement Requesting Stipends______Consultant Fee______TIMESHEETSSCHOOL: PROGRAM: Federal Programs PAYROLL FOR MONTH OF: DATES COVERED: through **EMPLOYEES 1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 NAME** 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 Mon th Mon thMon th Mon thMon th Mon thMon th Mon thMon th Mon thO = Present X = Absent I hereby certify the time shown above to worked for Federal Progams .-I hereby verify this to be true and accurate Principal______Federal Program employees sign on lines above. Due to the attention of Nancy Walker by the 1st of each month.

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