The following two steps below are required for the Albert Shanker Grant District Reimbursement.

1. The District Reimbursement form may be submitted by district personnel between April 15th and June 30th, 2019.  Please include all (2017-2018) candidates and submit one form per district.  The District Reimbursement form must be completed and submitted online.

2. The District Reimbursement Attestation must be submitted via mail with an original signature of the Superintendent or Chief School Officer to receive reimbursement. Print the Attestation form from the link at the bottom of this form and return the completed form via mail with an original signature of the Superintendent or Chief School Officer to receive reimbursement.

mail to:
New York State Education Dept.
Attention: Albert Shanker Grant Coordinator
89 Washington Ave., EB RM 4N
Albany, NY 12234

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* 1. District:

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* 2. Name and Title of person completing this form:

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* 3. Email:

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* 4. BEDS Code:
If you are not sure of your BEDS Code use the SEDREF Information Search Form.

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* 5. SFS Number:

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* 6. Check support services provided for NBC candidates: (Districts are responsible for maintaining appropriate documentation for support services)

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* 7. Name of each Albert Shanker candidate in your district who began the process on or after the 2016-2017 cycle and completed the NBC process in 2017-2018:

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* 8. Reimbursement Request (up to $500 per candidate):

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* 9. District Address:

Budget Summary

Please describe all applicable expenditures below and their cost. Codes correspond with NYS FS-10 form.

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* 10. Professional Salaries (ie. CSP stipends, substitute costs) - code 15
Cost:

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* 11. Purchased Services (ie. workshop fees, visiting CSP or content specialists) - code 40
Cost:

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* 12. BOCES Services - code 49
Cost:

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* 13. Supplies and Materials (including technology under $500) - code 45
Cost:

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* 14. Travel Expenses - code 46
Cost:

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* 15. Equipment (cost over $500) - code
Cost:

District Superintendent Attestation Form

Please download, print, and return with original signature via mail. See District Superintendent Attestation Form for submission information and instructions.

Thank you for your support!

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