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Title: IMM 5589 F : Liste de contrôle des documents - CONJOINT DE FAIT (INCLUANT LES ENFANTS À CHARGE) Author: Immigration, Réfugiés et Citoyenneté Canada
Court File No C4-05-5589 AGREEMENT WHEREAS, LakeWood Health
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Title: IMM 5629 F : Liste de contrôle des documents - Partenaire conjugal (incluant les enfants à charge) Author: Immigration, Réfugiés et Citoyenneté Canada
MEDICAL STAFF INITIAL APPLICATION CHECKLIST
o Must present for ID verification prior to completion of credentialing 18 Additional documentation may be required based on your specialty and/or clinical privileges (Note: case logs are required for Level 2 and Level 3 privileges) Please keep a copy of the documents submitted for your records Return all documents to:
STUDENTS WITH DISABILITIES Data Collection and Approval
02/25/2021 – 03/11/2021 Final verification and clean -up of December 1 st approval records by Funding and Disbursements Staff at ISBE 03/12/2021 – 03/26/2021 District Administrator certification of December 1st child count NOTE: No approval changes accepted 03/27/2021 – 04/07/2021 ISBE preparation of final child count file to USDE
OBJECTIONS / DOCUMENTS REQUIRED FOR TRASFER OF EST/SESE (FEMALE)
Verification of 1st appointment order in letter shape with No & Date • 1st Joining Report attested by the Drawing and Disbursing Officer • Photocopy of service book duly attested by the DDO/Dy DEO • Latest computerized pay slip attested by the DDO Above mentioned documents have not been found enclosed with the case
How to apply for incoming Study Abroad/Exchange program
Signature Documents: These declarations are mandatory and must be signed by the student Failure to do so will mean your application will be declined Please note: The signature verification documents will remain ‘un-received’ for some time until the Study Abroad Coordinator at MU reviews each application and ticks as received
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[PDF] Form 929 - Department of Immigration and Border Protection
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STUDENTS WITH DISABILITIES
Data Collection and Approval Instructions
--- 2022-23 School Year --- (November 2022)For use with I-Star
This is a compilation of procedures and instructions, supported by rules and regulations, to assist LocalEducation Agencies in reporting and approving
students with disabilities for reimbursementILLINOIS STATE BOARD OF EDUCATION
Special Education Department
100 North First Street
Springfield, Illinois 62777
Phone: 217-782-5589
Fax: 217-782-0372
TABLE OF CONTENTS
STUDENTS WITH DISABILITIES-DATA COLLECTION AND APPROVAL INSTRUCTIONS Page # General Instructions, 2022-23 December 1 Child Count Timelines 1 Special Education Private Facility - Residential PlacementsSpecial Education Orphanage Act Eligibility
Questions and Technical Support
2Specific Instructions:
Resident District
Resident School
Serving District
Percent Time in Special Education
3-5Fund Codes (entry procedures) 5
Fund Code Definitions
State Reimbursement Fund Codes
Fund Codes for Students Not Receiving Services
7 7-9 10-12Serving District and Serving School Table 13
Private Facility Code - Fund Codes B, F, and Q OnlyLast Name/First Name/Middle Name
Student Information System ID Number
Gender
14Race and Ethnicity Code
Disability Codes and Definitions
Grade Level
Language Code
15 15-17 17 17Related and Other Services 17-24
Educational Environment (EE)
Early Childhood Educational Environment Codes
24-27Educational Environment (Grades KG-12) 27-29
Unable to Locate Residential Placement ʹ NEW FIELD Percentage of Time Inside General Education Classroom: Grades KG-12Room and Board Payer
3030-31
Section 14-7.03 - Special Education Orphanage Eligibility 31
Placing Agent
Guardianship
TermBegin Dates
End Dates
3233
Reasons for Exit 34-35
State Performance Plan Indicator 8
State Performance Plan Indicator 11
3637-38
State Performance Plan Indicator 13 39-40
Nonpublic Proportionate Share Calculation 41
1STUDENTS WITH DISABILITIES
Data Collection and Approval
2022-23 School Year
GENERAL INSTRUCTIONS
The IEP Student Tracking and Reporting (I-Star) system is a web-based system used by the Illinois State
Board of Education (ISBE) that allows districts/special education cooperatives to input, manage, andapprove data for students with disabilities. I-Star serves as the primary approval process for students with
disabilities who are claimed for reimbursement under Sections 14-7.02 (Private Facility Tuition), 14-7.02b
(Students with Excess Cost), 14-7.03 (Orphanage), and 14-13.01b (Special Transportation) of the School
Code [105 ILCS 5]. Information for each student eligible for state reimbursement, even if only for part
of the school year, must be entered and approved in I-Star before funding can be claimed. The level of
payment is dependent upon the annual appropriation enacted for each program.Per Section 2-3.30 of the School Code, I-Star is also the system used to compile an unduplicated count of
students with disabilities reported annually to the federal government. Students counted must be eligible
to receive services or be in a Special Education Program receiving direct or related services approved by
a public school district on December 1, 2022; be at least age 3 through age 21 inclusive (i.e., through the
Individualized Services Plan (ISP) in place. It is critical that all students with disabilities who are receiving
services as of December 1 each year are reported accurately in an approved status. ISBE will only use
approved student data to compile and report the December 1 child count as well as process state reimbursement to districts that file claims.A record should be created for every student who has had initial eligibility determined whether or not
the student subsequently receives direct or related services. Every student who does not receive direct
or related services should be reported as Fund Code N or U by the serving district.2022-23 DECEMBER 1 CHILD COUNT TIMELINES
12/01/2022 Ensure all students are entered into I-Star in preparation for the
December 1 child count.
02/03/2023 Student Approval and IDEA Child Count Errors/Duplicates resolved
between districts and ISBE.02/22/2023 All corrections/additions for the December 1t child count closed.
02/23/2023 ʹ 03/09/2023 Final verification and cleanup of December 1 approval records by staff at
ISBE.03/10/2023 ʹ 03/24/2023 District administrator certification of December 1 child count
NOTE: No approval changes accepted.
03/25/2023 ʹ 04/07/2023 ISBE preparation of final child count file to U.S. Department of Education.
2 SPECIAL EDUCATION PRIVATE FACILITY - RESIDENTIAL PLACEMENTSPre-approval is required when a school district needs to place a student in a private residential facility if
the district will be paying the room and board costs. ISBE Form 34-37 (Application for Approval of Private
Residential Placement Room and Board Reimbursement) or ISBE Form 34-43 (Application for Emergency and Student-Specific Residential Placements in Nonapproved Facility) must be completed and submittedannually for approval. If you have questions specific to the residential approval process, please contact
the Special Education Department at 217-782-5589.SPECIAL EDUCATION ORPHANAGE ACT ELIGIBILITY
Students reported under Fund Codes D, E, and F must clear eligibility checks with the Illinois Department
of Children and Family Services (DCFS) to qualify for reimbursement under Section 14-7.03 Orphanage.QUESTIONS AND TECHNICAL SUPPORT
Questions pertaining to student approval should be directed to:Jamie Johnson
Illinois State Board of Education
Special Education Department
100 North First Street
Springfield, Illinois 62777-0001
Phone: 217-782-5589
Fax: 217-782-0372
Email: jjohnson@isbe.net
Questions pertaining to State Performance Plan Indicators 8, 11, and 13 should be directed to:Jodi Fleck or Kristina Holloway
Illinois State Board of Education
Special Education Department
100 North First Street
Springfield, Illinois 62777-0001
Phone: 217-782-5589
Fax: 217-782-0372
Email: jfleck@isbe.net or khollowa@isbe.net
Questions pertaining to the operation of I-Star should be directed to:Harrisburg Project
512 North Main
Harrisburg, Illinois 62946
Phone: 800-635-5274
Fax: 618-252-0704
Email: support@hbug.k12.il.us
3SPECIFIC INSTRUCTIONS
The names of all students receiving services under the Individuals with Disabilities Education Act (IDEA)
via an IEP or ISP services must be entered in the Student Information System (SIS) in order to generate an
the special education cooperative to which that district belongs are authorized to report student data.
However, the serving district for nonpublic parochial students with an ISP who are being served outside
their resident district must report these students (Fund Code L only) as long as the student is not dually
enrolled.If a student has changed resident districts but will be claimed for a portion of the 2022-23 school year in
entered in I-Star must align with the exit date recorded in SIS.Resident District
For every student record, enter the unique 11-digit Region-County-District-Type (RCDT) number assigned
by ISBE for public school district of residence. Section 14-1.11 defines residency for the parent of a student
with disabilities, and Section 14-1.11a defines residency for a student with disabilities.Section 14-1.11a Resident District: Student
The resident district is the school district in which the student resides when:1. The parent has legal guardianship but the location of the parent is unknown, or
2. An individual guardian has been appointed but the location of the guardian is unknown, or
3. The student is 18 years of age or older and no legal guardian has been appointed, or
4. The student is legally an emancipated minor, or
5. An Illinois public agency has legal guardianship and such agency or any court in this state has
placed the student residentially outside of the school district in which the parent lives.In cases where an Illinois public agency has legal guardianship and has placed the student residentially
outside of Illinois, the last school district that provided at least 45 days of educational service to the
student shall continue to be the district of residence until the student is no longer under guardianship of
an Illinois public agency or until the student is returned to Illinois.The resident district of a homeless student is the Illinois district in which the student enrolls for
educational services. Homeless students include individuals as defined in the Stewart B. McKinney
Homeless Assistance Act. [42 U.S.C. 11361 et seq.]Any student served in a school funded by the Illinois Department of Human Services (IDHS) may only be
reported by the resident district. The state superintendent of education may determine that the location of the parent or guardian of astudent is unknown after considering information submitted from the school district that last enrolled the
student or from the school or special education facility providing special education and related services
to meet the needs of the student. The information submitted to the State Superintendent of Educationmust include an affidavit from that school district's superintendent or the facility's director attesting that
4 the location of the parent or guardian is unknown and four items of documentary evidence that a minimum of four separate attempts were made to locate the parent or guardian. Any determination by the state superintendent of education that the location of a parent or guardian is unknown is final. However, any determination made by the state superintendent of education is subject to review and reconsideration any time a parent's or guardian's location becomes known.Students served by the following state charter schools -- Prairie Crossing, Southland College Preparatory
High School, Illinois Special Education Charter Cooperative, LEARN 9 Waukegan, Bronzeville Academy,Intrinsic II, Urban Prep West Charter School, and Betty Shabazz International ʹ may only be reported by
Report the serving district as the resident district for Fund Code L and N students who reside outside of
Illinois and attend a nonpublic school in Illinois.Resident School
For each student record, enter the unique 15-digit RCDTS number assigned by ISBE for a public school that
is valid for the resident district. The resident school represents the school in the district where the student
either attends for educational instruction or where the student would attend if educated at a school in
their resident district. The resident school can only be a public school attendance center.Serving District
Enter the unique 11-digit RCDT number assigned by ISBE for the serving district. The serving district
represents the Local Education Agency that operates the program. This may be the same as the resident
district or can be another public school district in Illinois. For certain fund codes, the serving district may
be a special education cooperative, a regional office alternative learning program, a state agency (e.g.,
IDHS) or other state-funded school (e.g., a laboratory school).Serving School
Enter the unique 15-digit RCDTS number assigned by ISBE for the serving school. The serving schoolrepresents the school or location where the student receives his/her educational instruction. This may or
may not be a school in the serving district. For certain fund codes, the serving school may be a state-
approved Special Education Program operated by a special education cooperative, a regional officealternative program, a state agency-funded school (e.g., Illinois School for the Deaf or Illinois School for
the Visually Impaired), or a nonpublic parochial school.ISBE has eliminated the Category X additional serving locations and unlisted locations. In the case of
home/hospital or an undetermined serving location, the serving location would be where the student either attends for educational instruction or where he/she would attend if he/she were educated at a school in his/her serving district.Percent Time in Special Education
Enter the percent between 1-100 that reflects the amount of time for which a student receives special
education and related services per their IEP at the time of entry into the Special Education Program as
during those times. 5Example:
John receives 950 Special Education minutes per week.Total instructional minutes per week = 1,680.
(950 / 1,680 = .565)*100 = 56.5 or 57%57% Special Education
This Percent Time in Special Education must be calculated individually for each student in the program.
Half-day preschool students who only attend the Special Education Program should have 100 percent entered.All students (except Fund Codes L, N, P, U) are required to have Percent Time in Special Education entered.
Fund Codes
Enter the one code letter appropriate for the type of program funding for which application is being made.
under any of the fund codes for which the student is eligible. Public Act 102-0172 amended the School
Code to allow students that turn 22 during the regular term school year to continue services through the
end of the school year. The day the students turn 22, their approval records should become Fund Code
A, D, E, F, H, K, L, P, or B. Fund Code B tuition records will only be allowed past age 22 for in-state day
school placements if the facility allows placements past age 22. Generally, a student may only be entered
once in a particular fund code and/or private facility code during each period of time indicated with a
begin and end date.If a student is placed in a private facility for tuition purposes and a residential facility paid for by the school
Star records must have the Dually Enrolled indicator checked. Likewise, if a student is placed in a private
school program by the school district for part of the day and in a public school program for part of the day
(necessitating the reporting of the student in both Fund Codes B and A or X), the Dually Enrolled box
should be checked.under both the first and second fund code designations, add an end date and Exit Code 20 in the entry for
the end date listed on the I-Star entry for the first fund code.If a student has been discontinued from a district program and at a later date during the school year re-
begin date for the second or subsequent entries. 6Fund Code Definitions
All students receiving services on December 1 are reported in Fund Codes A, K, L, P, B, D, E, F, H, Q, and X.
Eligible students are enrolled, have an appropriately developed IEP, and are receiving special education
and related services in public school district programs. A IDEA Child Count: Eligible students are enrolled, have an appropriately developed IEP, and are receiving special education and related services in public school district programs.Select the serving district and serving school, as appropriate. Students who are placed in a state agency-
funded school (e.g., Illinois School for the Deaf or Illinois School for the Visually Impaired) must be
reported by the resident district. K Nonpublic ʹ Dually Enrolled: These students are home-schooled or enrolled by the parent/guardian in a nonpublic (e.g., parochial) school for general education and are also enrolled, have an IEP, and are receiving special education and/or related services in the public school district. Select the serving district and serving school, as appropriate. The serving school may be either a public school attendance center or a nonpublic school depending on where services are provided. L Nonpublic ʹ Not Enrolled: These students are enrolled by the parent/guardian in a nonpublic (e.g., parochial) school for general education and are not enrolled in the public school district but are receiving special education and/or related services specified on an ISP that are provided by the public school district. Select the serving district and serving school, as appropriate. The serving school may be either a public school or a nonpublic school depending on where services are provided. P Home-Schooled -- Not Enrolled: These students are home-schooled for general education and are not enrolled in the public school district but are receiving special education and/or related services specified on an ISP that are provided by the public school district. Select the serving district and serving school, as appropriate. The serving school may be either a public school or a nonpublic school depending on where services are provided.State Reimbursement Fund Codes
B Section 14-7.02 (Private Day and Residential Facilities and Out-of-State Public Schools): Provides reimbursement for students placed in approved nonpublic facilities and in out-of-state public schools and includes both tuition and room and board. The tuition formula is specified in Reimbursement Procedures for Students with Disabilities. Funding is paid quarterly during the school year after service is provided. When a residential placement is necessary and no other agency has agreed to pay room and board, approval should be sought on ISBE Form 34-37. After approval is received, 7 payment of room and board costs based on rate approvals and dependent upon funding availability may be made on a current basis during the school year in which service is provided. Select the private facility where the student is being educated. Emergency rules for 23 IAC 226 and 23 IAC 401 allow for emergency and student-specific placements in non-approved facilities when no approved facility accepts the student or has immediate placement availability. To qualify for reimbursement of the costs of these emergency and student-specific placements, districts must demonstrate good faith efforts to locate an approved facility and must ensure the facility meets the criteria as set forth in the emergency rules.Use Fund Code B for the following scenarios:
Emergency placement at an approved facility and will be reimbursed for tuition and residential claims with an approved 34-37 application. Emergency placement at a non-approved facility and will be reimbursed for tuition and residential claims with an approved 34-43 application. Due process placement at an approved facility and will be reimbursed for tuition and residential claims with an approved 34-37 application. (Use Fund Code Q for due process placement at a non-approved facility, and reimbursement for tuition and residential with an approved 51-77 and 51-77A.) Agency placement at an approved facility and will be reimbursed for tuition only. (Use Fund Code Q for agency placement at a non-approved facility. Districts will not be reimbursed for tuition or residential claims.) To report emergency placements at non-approved facilities in I-Star: Click ͞Emergency or Student Specific Placement.͟Non-approved facilities will then be available in the private facility dropdown as an option, if applicable.
Emergency placements for tuition and residential will require two records in I-Star. The tuition records
will require matching SIS data to be approved. To report due process or agency placements at non-approved facilities in I-Star:Change the current Fund Code to ͞Q͘͟
Choose the appropriate Placement Type.
Non-approved facilities will then be available in the private facility dropdown as an option, if applicable.
Due process placements for tuition and residential will require two records in I-Star. The tuition records
will require matching SIS date to be approved. 8 D Section 14-7.03 (Orphanage Act): Provides full tuition reimbursement for eligible students who attend public school educational programs and are placed in a residence for the purpose of care/custody, welfare, medical/mental health treatment, rehabilitation, or protection by an Illinois public agency with authority over and responsibility for the students. This fund code may only be used with written authorization from the Illinois State Board of Education. Use of this fund code requires the completion of Type of Residence, Placing Agency, and Guardianship Codes. An eligibility check is conducted for each student reported for this fund source, with additional information required for students who cannot be verified as Youth in Care of DCFS. Please note that, in order to be eligible for reimbursement under district of residence of a parent or court-appointed individual guardian per the requirements of 23 Ill. Adm. Code 226.770(e). Estimated funding is paid quarterly during the school year in which service is provided. Select the serving district and serving school, as appropriate. E Section 14-7.03 (Orphanage Act--Individual Programs): Provides full tuition reimbursement for eligible students who attend public school educational programs and who are placed in a residence by an Illinois public agency or court in this state. Eligibility for reimbursement is driven by a determination of residency under Sections 14-