School Procedures packet

2012-2013

Welcome All Students and Families to Delta/Greely Homeschool. DGH has been redesigned to follow the correspondence format of statewide programs that have been successful over the past decade. It is our desire to have a program that meets the needs of all students residing in the Delta/Greely Regional Education Attendance Area who choose to home school. Contained within this packet is much of the information that you will need to understand how the program works, the procedures that need to be followed and the important program requirements. DGH is designed to allow for parent choice and flexibility as allowed by the State of Alaska Correspondence Regulations. We recognize that programs need to constantly morph to meet the ever changing needs of our students, so we encourage you to offer your opinions and suggestions for improvement. We are here to serve you. Sincerely,

Laural Jackson, Principal

Table of Contents Contact Information……………………………………………….…………… Page 1

Important Dates………………………………………………………………… 2

Program Requirements/Noncompliance………………………….…………….. 3

Guidelines for Daily Instruction……………………………….………………. 4

Grading Scales…………………………………………………..……………… 5

Examples of Monthly Contact………………………………………………….. 6

Religious Materials/Instruction……………………………………………….... 7

Taking Classes at Other DGSD Schools……………………………………….. 7

Graduation Requirements…………………….………………………………… 8

DGH computer program…………………………………………………….….. 10

Internet…………………………………………………………………………. 11

The Allotment/Allowable Expenditures……………………………………….. 12

Reimbursement Instructions…………………….……………………….…. 13

Pre-Approval of Purchase Form……………………………………………… 14

Reimbursement Form…………………………………………………………... 15

Special Instructor Packet……………………………………………………….. 16

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Contact Information DGH Office Contact Teacher Holly Stewart 895-1043 ext 28 hstewart@dgsd.k12.ak.us Secretary Char Lundy: PO Box 369 Delta Junction, AK 99737 phone: 895-1043 ext 25 fax: 895-5198 clundy@dgsd.k12.ak.us Principal Laural Jackson 895-4657 ext 24 ljackson@dgsd.k12.ak.us

Facebook: DGH on-line

http://www.facebook.com/pages/DeltaGreely-Homeschool/280657465279984 Website: deltagreelyhomeschool.weebly.com DGSD Counseling Website http://huskycounseling.weebly.com/

PAC (Parent Advisory Council)

895-1946 (home) Kathi Jurva

kathijurva@hotmail.com

895-1857 (home) Andrea Richard

(907) 750-0035 (cell) andrea.richard@acsalaska.net

895-9904 (home) Hannah Hudgin

803-3792 (cell) hudginfam@acsalaska.net

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IMPORTANT DATES FOR 2012-2013

July 1, Funds available for 2012-2013. September 1 Eligible for Kindergarten (if 5 yrs. old on or before) October 2-4 HSGQE Retakes (for 11th and 12th graders) October 12

Mid-Semester 1 Progress Report and work samples due

October 19 Kindergarten Developmental Profile due December 21 End of Semester 1:

Semester 1 Grades and work samples due

January 31, 2013 Deadline to submit reimbursements for all expenditures July 1—Dec 31 February 7 Terra Nova Testing for grades 5 and 7 March 8

Mid-Semester 2 Progress Report and work samples due

March 11 Last day to add a course to an ILP . April 2-4 State Mandated Testing SBA testing 3rd - 9th grade (Reading, Writing, Math) HSGQE for 10th - 12th grade (plus adult retakes) April 5 SBA (Science) for 4th, 8th, and 10th graders May 1 Graduating seniors must have all work completed. May 15 Deadline for 2nd semester reimbursements with original receipts.

Deadline to encumber funds for May/June lessons. May 17 Graduation May 17

Semester 2 Grades and work samples due

June 15 Deadline to turn in your original receipts for May/June encumbered funds.

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Program Requirements: Monthly Contact:

Contact should be initiated by the Home Educator (Parent) before the end of every month. Please see the enclosed Monthly Contact document for more information on what information is desired for monthly contacts. We might also ask you how many hours your student has spent on each course, if additional resources or a home visit are desired, and etc..

Progress Reports and Work Samples:

There are four reporting deadlines during the school year; specified on page 2, Important Dates for 2012-2013. Specific details are required in the Progress Reports for each course listed on the ILP; the details needed are determined by the Contact Teacher and Home Educator. A work sample is also required for each course listed on the ILP. Work samples are agreed to by the Contact Teacher and Home Educator.

State Testing: This includes: developmental profiles, SBAs, Terra Novas, WorkKeys, and HSGQEs. It may also include the ACCESS test if your student is an English Language Learner.

All 3rd - 12th grade students are required to participate in standardized testing.

Non-Compliance Course of Action:

A family will be considered Non-Compliant if they do not maintain monthly contact or submit a Progress Report and Work Samples on time. 1st warning: Home Educator will be contacted with details about what they need to submit, and by when, to become compliant. Family accounts will be ‘on hold’ until documents have been received. 2nd warning: Home Educator will be contacted by certified letter about what they need to submit, and by when, to become compliant. Family accounts will be ‘on hold’ until documents have been received. 3rd warning: DGH will withdraw any student whose documents do not show adequate progress. Accounts will be closed. Students who do not participate in state testing will placed on “probation” until the following year’s testing is complete. This means family accounts will only be allowed to be used for curriculum until the next year’s testing is complete. (Reimbursements will be held until after the testing has been completed.)

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Guidelines for Daily Instructional Time

Subject Grades K - 3

Grades 4 - 6

Grades 7 - 12

Language Arts: Grammar, Literature, Spelling, Reading, Writing, Speech

120 135 135

Math 45 55 60

Science/Health 25 35 50

Social Studies 25 35 50

Physical Education 20 25 30

Music/Art/Technology 15 30 35

Total 4 hours 5 h 15 m 6 hours

Some days might take longer to cover a topic, some days might be shorter, some weeks might have to spill over into the weekend...that’s homeschooling. The important thing is that your child is getting the best education possible...however long that takes.

It’s not enough to be busy, so are the ants. The question is, what are we busy about? Henry David Thoreau

Average Minutes per Day

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Grading Scales

For grades K-3 please use the following grading scale:

Letter Grade Percentage Meaning E 90 - 100 Excellent P 70 - 89 Proficient N 0 - 69 Not proficient

For grades 4 - 12 please use the following grading scale:

Letter Grade Percentage GPA pts/credit A 93 - 100 4.0 A- 90 - 92 3.7 B+ 87 - 89 3.3 B 83 - 86 3.0 B- 80 - 82 2.7 C+ 77 - 79 2.3 C 73 - 76 2.0 C- 70 - 72 1.7 D+ 67 - 69 1.3 D 63 - 66 1.0 D- 60 - 62 0.7 F 0 - 59 0.0

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Monthly Contact Example

Here is an example of an e-mail from one Home Educator (names have been changed): Oct. 8th Randy: He is almost finished with his first quarter of math. He has been having problems with his 3 digit multiplication so we have been doing extra work on that. He knows his facts, but makes silly mistakes such as carries the number in the wrong place value spot. He just finished his first unit on poetry and did very well. The kids had to plan a coffee house reading. (setting, menu, drinks, backdrop and poems) He began writing poems on his own. Spelling is going well, half way through level. Science and Social....Just finished the 50 states and now beginning a year long ocean study. We will begin a ww2 study in the coming weeks. Sam: He finished his first quarter of math. He is doing very well. Spelling is also going very well. In Lang. Arts he also did the coffee house read. Performed well and was very clever with his poems. He defiantly has the creepy, goofy personality. lol He also learned about the 50 states and will begin the ocean and ww2 studies. Jennifer: She finished her first quarter of math. Did very well. Learning lots of geometry now and doing well. She is still on lesson 45/120 in spelling. SHe is doing great on her spelling test though. Again, Jenni performed in the coffee house read and spoke very clear and was not nervous. (she has a hard time with public speaking) Her poems were well written. She is excited to learn about the oceans and ww2. Marlee: She finished her first unit in lang. arts. She planned a frontier dinner for her family. She studied the Little House on the Prairie. Her spelling and math are going very well. She too finished the first quarter. She is eager to learn her multiplication facts so she is doing additional work on those. She has begun cursive writing as well. She joined the older kids with the 50 states and will begin the ocean studies. She is very excited for that. Mark:

He had a slow start to school. It took him up until last week to get in the groove. His spelling is now doing better; he had a rough start on review. His math; we tested him into it and he got to skip the first 30 lessons. On writing he has done very well. He has already written 3 papers (a paragraph each). He even wrote a letter to a soldier in Afghanistan. We will update you on that!

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Religious Curriculum Materials

Per state regulations, public schools may not purchase any faith-based curriculum or products. Also, faith-based courses may not be used to determine a student’s full-time status. This means that at least four courses need to be able to be paid for by DGH for the student to be considered full-time and eligible for a full allotment; courses using faith-based curriculum are not allowed to be counted towards the four courses. However, parents are still allowed to use and purchase faith-based curriculum themselves. Credit can be designated for these courses as long as they meet the same requirements as nonsectarian courses (reviewed by the Contact Teacher, are included in the ILP, and Progress Reports and Work Samples are received.) These courses will be noted on the transcript outside of the DGH program. Example of acceptable ILP, noting faith-based courses: Language Arts - Abeka Math - Saxon Science - Abeka Social Studies - Abeka Physical Education - PDC Technology - BYU Art - Artelier

Taking classes in other DGSD Schools Students are able to take classes from other Delta/Greely Schools. For example a student enrolled in Delta/Greely Homeschool may take classes at Delta High School. The courses will each cost $150/semester from the student allotment and students are expected to meet the same attendance and course work requirements as other students in the class. Students who are enrolled in other DGSD Schools are under the supervisory responsibility of the school only during the times of their assigned classes and may not remain at the school beyond those classes unless other accommodations have been made with the site principal. It is the DGH student/family’s responsibility to provide transportation to/from the courses; however DGH students are allowed to use the District bus service when that coincides with the start/finish of their classes.

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Delta/Greely Homeschool Graduation Requirements

Class of 2016

Student: ________________________________DOB:_____________ Phone: H:____________ C:______________ Mom:__________________________Dad:_____________________

*English I (1 credit) English I, 1st semester _______ Language Arts: 4 Credits Grade

English I, 2nd semester _______ *English II (1 Credit) English II, 1st semester _______ English II, 2nd semester _______ English Elective (1/2) ______________________________ _______ English Elective (1/2)_______________________________ _______ English Elective (1/2) ______________________________ _______ English Elective (1/2)_______________________________ _______

*Algebra (1 Credit) Algebra, 1st semester (1/2)_______________ ________ Mathematics: 3 Credits Grade

Algebra, 2nd semester (1/2)_______________ ________ Math Elective (1/2)______________________ ________

Math Elective (1/2)______________________ ________ Math Elective (1/2)______________________ ________ Math Elective (1/2)______________________ ________

*Biology (1 Credit) Biology, 1st semester___________________ _______ Science: 3 Credits Grade

Biology, 2nd semester__________________ _______ Science Elective (1/2)__________________ _______

Science Elective (1/2)__________________ _______ Science Elective (1/2)__________________ _______

Science Elective (1/2)__________________ _______

*US History (1 Credit)US History, 1st semester (1/2)____________ _______ Social Studies: 4 Credits Grade

US History, 2nd semester (1/2)____________ _______ *AK Studies (1/2 Credit)AK Studies (1/2) _____________________ _______ SS Elective (1/2)_______________________ _______

SS Elective (1/2)_______________________ _______ SS Elective (1/2)_______________________ _______ SS Elective (1/2)_______________________ _______ SS Elective (1/2)_______________________ _______

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PE/ Health (1/2)______________________ _______ Physical Education/ Health: 1 Credits Grade

PE/Health (1/2)______________________ _______

FA/FL Elective (1/2)___________________ _______ Fine Arts or Foreign Language: 1 Credit Grade

FA/FL Elective (1/2)___________________ _______

Elective (1/2)_________________________ _______ Electives: 6 Credits Grade

Elective (1/2)_________________________ _______ Elective (1/2)_________________________ _______ Elective (1/2)_________________________ _______ Elective (1/2)_________________________ _______ Elective (1/2)_________________________ _______ Elective (1/2)_________________________ _______ Elective (1/2)_________________________ _______ Elective (1/2)_________________________ _______ Elective (1/2)_________________________ _______ Elective (1/2)_________________________ _______ Elective (1/2)_________________________ _______

*Required Courses Total Credits: 22

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DGH Computer Program

Pre-requisites to be eligible to participate in the DGH Computer Program: ¨ There must be at least one student enrolled full-time through the month of October. ¨ One computer option is available for families with 1 - 3 students; two computer options are

available if there are 4 or more students. -The computer programs are only available through March of each academic year

Computer Purchase-Reimbursement Program

This computer purchase program is designed for families wanting to have specific computer options to match their particular educational needs. The family can purchase a computer of their choice and receive three reimbursements per year to help pay for the cost of the computer. Forty dollars ($40) per month will be reimbursed from the purchase date based on the following payment schedule until full reimbursement level is reached:

o 1st Reimbursement (July-November): November 30th o 2nd Reimbursement: (December-February): February 28th o 3rd Reimbursement (March-June): April 30th

Original receipt for computer is required Payments will begin after full time enrollment is verified in November Payment will continue upon receipt of quarterly reports and work samples Month of purchase will determine payment start date. This reimbursement does not come from the student allotment For eligible students who re-enroll, payments will continue automatically the

following November.

One Time $199 Reimbursement Program

Families may choose to purchase a computer and receive a one-time reimbursement of up to $199 for the cost. This reimbursement does not come from the student’s account. Preapproval is required and reimbursement will not occur until after the student has been enrolled for the entire student count period in October.

DGSD has some good used computers that will be loaned to families in need. These computers are available on a first come first served basis and may be limited in number.

Computer Assistance Program

Available for students enrolled full time through the October count date. $50 user fee/year is responsibility of family One computer per every 3 students Computer will be relinquished to the family after two years of enrollment with the

program Family is responsible for maintenance of the computer

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Internet Stipend

Delta/Greely Homeschool will reimburse families for access to the internet. The family must have at least one student enrolled full-time in the DGH program through the month of October each academic year. The stipend allowable is not to exceed $10.00 per student per month. Original receipts or documentation is required for reimbursement. Internet charges must be clearly marked upon the receipt for eligibility. Receipts showing “bundled” services will be reimbursed for internet access only. Charges for usage fees and modem rental will be deducted from the reimbursed amount. Credits provided for cable, long distance fees and taxes will be excluded when determining the amount to be reimbursed. These expenses are considered personal and /or entertainment and are prohibited by regulation. This stipend is provided outside of the student allotment. Note: The reimbursement form and receipts for May internet services must be received by June 15th. June internet may be reimbursed in July for students who re-enroll.

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THE ALLOTMENT/ALLOWABLE EXPENDITURES

Grades K-3: $1700

Grades 4-8: $1900

Grades 9-12: $2100

There is a $75bonus added to the allocation for families who enroll prior to May 15, 2012.

As per regulation 4 AAC 33.421 (k), a statewide correspondence study program may not

(1) family travel, including transportation, food, or lodging; or for expenses during, or for any out of state travel unless a governing body or superintendent of the district approves expenses incurred in the out-of-state travel that are associated with direct instructional activities; in this paragraph, “family travel” does not include travel in which a student is accompanied by the student’s family for assessments or other required activities initiated by the district;

pay for or provide money for:

(2) annual passes or family memberships to a sports or recreational facility; however, an annual pass or membership for the student may be purchased for entry into sports or recreational facility in which the student is provided lessons under the student’s Individual Learning Plan, if the cost of the pass or membership is prorated to include only the cost of the student’s instructional time; (3) fees that allow entrance to a facility in which no instruction directly connected to a student’s Individual Learning Plan under (e)(1) of this section is given; (4) religious, partisan, sectarian, or denominational textbooks or other curriculum materials; (5) services provided to a student by a family member; in this paragraph, “family member” means the student’s spouse, guardian, parent, step-parent, sibling, step-sibling, grandparent, step-grandparent, child, uncle, or aunt; (6) clothing, uniforms, physical education equipment, or personal items; (7) pets and other animals;( no “animals or related equipment” ie. bees, eggs that will grow into animals, reptiles or insects, ant farms, etc. will be allowed.) (8) furniture; (9) taxes, testing other than educational assessments required by the district, or parking fees; (10) entertainment; (11) permanent items that adhere to or enhance the value of a non-school facility; or (12) items that are considered excessive by the school administrator. As per 4 AAC 33.422. (b): Textbooks, equipment, and other curriculum materials purchased with state money, including money provided to the parent through a fund account, are property of the district. Materials that are not consumables must be returned to the district when the student leaves the program for any reason. DGH considers curriculum materials from $199.99 or under to be consumable and not subject to return after the student is finished with the material Equipment which is purchased and costs less than $199.99 is depreciated over three years after which time it will be relinquished to the family. Should the family leave the program prior to three years time, the equipment is expected to be returned to the District. Any item purchased by the district over $199.99 must be returned after the student leaves the program. Items returned are placed in the parent resource room or placed on the District surplus item list for sale to general public.

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Reimbursement Instructions

• Please submit receipts periodically throughout the year

• All items purchased or reimbursed for your student must have an educational purpose related to their ILP. Purchases must be reasonable and reflect student goals.

to ensure your reimbursements are processed in a timely manner.

• If you have a questionable purchase please submit a Pre-Approval form to your CpC Contact Teacher (prior to purchasing).

• Delta/Greely Homeschool reserves the right to deny any purchase if it violates district, state, or federal policy, rules or regulations.

•

Excessive spending at the end of the school year will be denied.

¨ Number your receipts please Requirements for completing the Reimbursement Form:

¨ Date - please write in mm-dd-yy format, date must appear on the receipt ¨ Student Name—who the purchase was for ¨ Vendor Name must appear on the receipt ¨ Description of product, service, etc. ¨ Course—which class did the purchase relate to ¨ Educational Purpose—what purpose did the purchase serve ¨ Total Cost must appear on the receipt (DO NOT include sales tax) ¨ Total Amount—total of all receipts in the Total Cost column ¨ Attach all receipts and submit to your DGH teacher for approval

· Attach original receipts to an 8 1/2” x 11” sheet of notebook or printer paper. Some bookkeeping how-to’s:

· Write your family name and number on the top of the sheet. · Keep all receipts in the same direction. · Do not use highlighters on receipts and do not write over any printing on the receipt · Next to the receipt please write which line on the Reimbursement Form it corresponds to. · Next to the receipt please write what the purchase was for if it not already obvious. · If the receipt just lists ‘book’ you will need to write the title of the book next to the receipt. · On the receipt, the business office needs to be able to see the vendor, date, description

and price of each item, total amount paid, method of payment, and any tracking information as proof of your purchase.

Unacceptable “receipts”: · Xerox/faxed/scanned/emailed receipts · A statement with a Balance Due · Carbon copies or bank copies of checks · Price tags • Receipts with dates prior to enrollment or after withdrawal.

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Pre-Approval for Reimbursement

· All purchases must be appropriate expenditures of public funds as per DGH Parent Student Handbook. · All expenditures must be directly related to student’s ILP. · This form must be submitted PRIOR · Letter of alignment and request must be submitted with this form for out of state expenditures.

to purchases.

Family Name:_____________________________Date Teacher: _____________________

Phone # _____________________

Parent Signature: __________________________ Administrator Signature: _____________________________ Teacher Signature: _________________________ Date received at DGH: ______________________________

Student’s Name Name of Vendor

Descriptions of Equip./Materials/Service

Course Cost Approved Amount

Explain the Educational Purpose and Justification:

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REIMBURSEMENT FORM

Family Name: Phone:_____________________ Date: Teacher:____________________ *Items must relate to each student’s ILP and be approved by Advisory Teacher to be processed.* Individual receipts not taped to an 8 1/2”x11” paper may cause a delay in processing.

# of Re- ceipt

Date Student Name

Vendor Name Description of Purchase/ Service

Course Educational Purpose (Supplies, Curriculum,

Instruction)

Total Cost

1

2

3

4

5

6

7

8

9

10

Total Parent Teacher Signature: ________________________________________________ Advisory Teacher Signature: ______________________________________________ Principal Signature: ____________________________________________________

Family # ____________

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Special Instructor’s Packet

Welcome! Delta/Greely Homeschool welcomes tutors, instructors and instructing institutions of art, music, dance and physical education to join our vendor list. As a Special Instructor for DGH you are offering a service that meets an educational need identified in an Individual Learning Plan of a student. Our vendor list is distributed to each family enrolled in our correspondence program. If you prefer not to be listed, you may still offer your services to the families of the program.

We require a business license and resume’ or other information showing your qualifications for the credibility of the student’s educational accomplishments. We also require that you allow us to complete a background check to help ensure the safety of our students.

The cost of the background check will be deducted from your first payment. Generally the cost runs from $10 to $50 depending on how often you have moved.

For students in grades 7-12, lessons which constitute a grade on the student’s report card for fine arts do require that a Highly Qualified Certified teacher of that subject area oversee the planning and grading of the program. DGSD will provide this oversight as part of the DGH program.

You can be paid one of two ways:

Payment from DGSD: After establishing yourself as a vendor (complete Special Instructor’s Information Form and Agreement for Services Form) we will generate a Purchase Order with a unique identifier number for these specific services. You may then invoice the District after services are provided by sending an itemized bill attached to the Vendor Direct Payment Request Form. Payment will be made within two weeks after the District receives the invoice. This method of payment does require that you complete and return to us a W-9 Tax Form be completed and the District will generate an IRS Form 1099 for your business at the end of the calendar year.

Payment from Parents: You may ask the parent to pay you and then provide them with an

itemized receipt stating the amount received from the parent, the date and your signature. The parent can then submit it to us for reimbursement.

PLEASE NOTE: Delta/Greely School District is Tax Exempt

Thank you.

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Agreement between Family and Provider for “Special Instruction” services to Delta/Greely Homeschool student(s)

Student(s) Name(s): ________________________________________________________________________ Contracted Provider’ Name: _________________________________________________________________ Subject Area: (Check one) _____ Music _____ Art _____Other Number of Lessons _____ X Cost Per Lesson ________ X number of students ________= Total Cost ________ Start Date and End Date of Lessons:________________________________ Lessons may be provided only by providers having a business license to provide said lessons and have provided DGSD with a copy of the license as well as appropriate tax forms. This agreement can be terminated at family request at any time. Lessons provided up to that date will be charged to the account.

Agreement to Participation by Contracting Provider

My signature below indicates that I have met with the family and student and we have agreed upon the lesson schedule outlined above. I will be paid by the District upon receipt of invoice each month per the Special Instructor’s Packet. End of school year invoices must be received by June 15. A copy of my business license is attached. _________________________________________________________________________________________ Printed Contractor’s/Business Name Contractor’s Signature Date

Agreement by Correspondence Parents

My signature below indicates that I do wish to have lessons for my child as outlined above. I agree to have the cost of the lessons deducted from my child’s correspondence allotment upon receipt of an invoice by the contracting teacher each month. I understand that it is my responsibility to provide transportation to and from the lessons and that the District accepts no liability related to this provider who was chosen by the parents to provide a service. If at any time, I should decide to discontinue lessons, I may do so by calling the Delta/Greely Homeschool and the Contracted provider. _________________________________________________________________________________________ Printed Parent’s Name Parent’s Signature Date

___________________________________________________________________________________________________ School District Approval:

Printed Principal’s Name Principal’s Signature Date ___________________________________________________________________________________________________ Printed Superintendent’s Name Superintendent’s Signature Date For Office use only: DGSD Account Code: __________________________________________

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Special Instructors Information Form Business Name: ___________________________________________________ Contact Person: ___________________________________________________ Address: ________________________________________________________ _______________________________________________________________ Phone Number: ___________________________________________________ Fax Number: _____________________________________________________ E Mail: _________________________________________________________ Federal Tax ID or Social Security Number: ______________________________ Subjects Taught: _________________________________________________ Are you Alaska Certified: Yes No Please include a copy of your resume, brochure, or other documentation of our qualifications, along with any details that would assist in our approval process. Attached _____ Already on file _____ I prefer to be paid by: DGH _____ Family _____ Rate Scale: Individual Instruction Group Instruction Per Lesson $_________________ $_________________ Per Month $_________________ $_________________ Per Week $_________________ $_________________ Per Session $_________________ $_________________ Please read and sign:

• I understand clearly that the family, not the District, is retaining your services • The DGH Reimbursement or Vendor Direct Payment Request Form is required in order

for payment to be rendered either to the parent or to you. • Payments or reimbursements will not be made by DGH until after the services are

rendered. • Payments will not be made in excess of the rate stated in this agreement. Any excess

amount incurred is the responsibility of the family. • DGH is prohibited from paying sale tax. • The family is responsible for all payments of guided instruction. If there is any disparity

between what you bill and what we pay, this difference is the family’s responsibility and must be resolved between you and them.

Instructor Signature: ___________________________ Date: ______________

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Vendor Direct Payment Request Form

Vendor Name: _______________________Purchase Order Number:______________ Students/Family to whom you are providing service: ___________________________ Amount of Payment being requested: ______________________________________ Date: _____________________________________________________________ Please attach official invoice that includes the business name, address and contact information and itemizes the services provided (student names and dates of service) for which you are requesting payment.