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School Information Form Louisiana State Department Of Education Data Management (Please Type or Print)

Date: __________________________ Parish/Sponsor: ______________________________________________

Parish Code: ________________________________

School Name: (Please note that the length should not exceed 46 characters.)______________________________________________ Street Address: _________________________ Street Address City: __________________ Street Address Zip +4 _____________ Mailing Address: ______________________ Mailing Address City: __________________ Street Address Zip +4 _____________ Phone Number, including extension _________________________________

Fax Number: ______________________________

School Electronic Mail (E-Mail) Address: _________________________________________________________________________ Institution Control: ____________________________________ Institution Funding: _______________________________________ Institution Type: _______________________________ __________ Is site within city limits? (Check one.) Yes _____ No _____ Is tuition charged? (Check one.) Yes ______ No ______ Submission(s): (Circle the ones that apply.)

Annual School Report

Religious Affiliation Code: _________

SIS

PEP

Congressional District _______

Date School will start to operate (or started to operate) for the first time: MM/DD/YYYY ___________________________________ If your school has applied for and received approval for state aid under the Brumfied Vs. Dodd court order, please give the date it was approved: _________________________ Grades Taught: (Circle the ones that apply.) 01

02

03

20

24

25

04

05

06

07

08

09

10

11

12

13

14

15

Organizational Pattern Code (For Grade 6 only): __________________ School Business Partnership Count: ___________________ Chief Administrator: First Name, Middle Initial, Last Name, Suffix (Jr., Sr., etc.) _________________________________________ Official Title of the Administrator: __________________________________________________________________________ Facility type Code: ___________________________________________________________________________________________ Program Offered Code(s): _________________________________________________________________________________

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