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): _________________________________________________________________________________