School Verification

This form should be submitted to KDE if school cannot be found in the Directory of Low Income Schools for Teacher Cancellation Benefits. For the current school year, KDE will update each qualifying school in April based on low income data provided by School and Community Nutrition. This form will not be approved unless it is completed/verified by a school administrator or district official.

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* Contact Name

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* Contact Email Address

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* Date of Submission:

Date

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* Select District Name

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* School Name
enter the official name of the school

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* Select low grade of school

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* Select high grade of school

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* Total Enrollment (A)
Enter total enrollment for school

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* Total Low Income Students (B)
students receiving free or reduced lunch

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* % Low Income Students
Calculate total low income (B) divided by total enrollment (A) multiply by 100, with 1 decimal place (Example: 30.1%)

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* Select school year in which low income total is applicable
School years previous to 1998-1999 are not eligible

A school or district administrator must certify the data entered above is accurate.

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* School or District Administrator Name:

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