Annual School Survey

Purpose

The Palau Ministry of Education, in its effort to formalize an annual school report for all
schools within the Republic, has developed an Annual School Survey. The purpose of
this survey is to collect school data which will be used to compile a comprehensive
report on elementary and secondary education. Results of the survey will be made
available to school principals and administrators for planning and management purpose.
Data being collected through this survey are classified into the following categories:
school information, course information, personnel information, and plant and facilities.

School principals shall be responsible for completing the Annual School Survey to close
out this school year and for submitting it to the Division of School Management by May
21, 2004. Any questions regarding this survey can be directed to the Division of
Research and Evaluation at 488-2570.


Directions for Completing the Annual School Survey

Heading

• Fill in current school year on the line provided.

• Fill in the beginning and ending dates of current school year

School Information

1. Name of School: Write the full name of the school on the line provided.
2. Mailing Address: Write the mailing address of the school on the line provided.
3. School Principal: Write the full name of school principal on the line provided.
4. Contact Numbers: Write contact numbers for the school (telephone, fax, and email
address) on the lines provided.



5. School Type: Mark appropriate box to indicate school type.

1


• Public: refers to schools established and run by the government
• Religious Organization: refer to schools which are sponsored, owned, and
managed by religious organizations

• Private Enterprise: refers to schools solely owned and run by private authorities

• Other: refers to any type of school not mentioned above, (i.e. foreign school)

6. School Level: Mark appropriate box to indicate school level and circle corresponding

grade levels.


7. School Region: Mark appropriate box to indicate the location of the school.

• Central: refers to schools located in Koror and Airai

• Babeldaob: refers to schools located on Babeldaob, excluding Airai
• Outlying States: refers to schools located in Kayangel, Peleliu, Angaur, and

Southwest Islands

8. Class Session: Mark appropriate box to indicate daily class sessions
• Students attend classes full day: refers to all students attending classes in the
morning and the afternoon.
• Students attend split class sessions: refers to one portion of student population
attending classes in the morning while the other portion attends classes in the
afternoon.
• Fill in the number of classes taught per day on the line provided.

• Indicate the length of each class in minutes on the line provided.


Course Information


9. List all subjects taught by grade level:
• Note: indicate title of main textbook to show focus of subject taught if there isn’t
a specific course title.


Student Information

10. Students by age, grade, and gender:
• Fill in the number of all students (including those in Special Education) who are
enrolled in school by age, grade, and gender in appropriate cell.

11. Special Education students by grade and gender: For each grade, indicate the
number of students in Special Education Program.
• Full-time: refers to students who receive Special Education services in all
subjects.
• Part-time: refers to students who receive Special Education services for only
particular subjects, aside from their regular classes.

2


12. Repeaters by grade and gender: Fill in the number of students who repeated the
same grade as that of previous year.

13. Transfers by grade and gender: Indicate number of students who transferred to and
from other schools by grade and gender.

• Transfer Out: refers to students who transferred out to other schools

• Transfer In: refers to students who transferred in from other schools

14. Dropout/Withdrawal by grade and gender: Indicate number of students who dropped
out or withdrew from school during current school year.
• Dropout: refers to students who stopped coming to school or withdrew from
school due to academic failure
• Withdrawal: refers to students whose parents withdrew them from school for
valid reasons such as migration and illness.

15. Number of sections by grade: Indicate number of sections by grade levels

• Sections: refers to distinct classes or student groups within a grade level

16. Projected Enrollment for next school year: Indicate expected enrollment by grade
level for a next school year.



Personnel Information

17. School Personnel: Indicate total number and list all employees at school site by the
following: last name, first name, date of birth, position, highest level of educational
attainment, and years of experience at current position.

• Use additional sheets if needed.



Plant and Facilities

18. Number of school buildings: Indicate number of school buildings.

• School buildings: refers to all building structures belonging to the school.

19. Number of instructional facilities: Indicate number of instructional facilities available
at the school. If a certain type of facility is not available, write ‘0’.

20. Number of furniture and equipment: Indicate number of furniture and instructional
equipment available at the school. If a certain furniture or equipment is not available,
write ‘0’.


3

21. Number of other facilities: Indicate number of other facilities available at the school.
If a certain type of facility is not available, write ‘0’.

22. Availability of support services: Mark appropriate box to indicate support services
available at the school.



School Income

23. Income by source: State school income by source in dollars
• National Government: refers to funds allocated to school by the National
Government or the Ministry of Education

• State Government: refers to funds allocated to school by the State Government
• Sponsoring Organization: refers to funds allocated to school by the organization
sponsoring the school
• Student Fees: refers to income, collected by the school from students.
• PTA: refers to financial assistance contributed by Parents Teachers Association
or similar organization.
• School Fundraising: refers to income raised through fundraising activities
sponsored by the school.
• Donations: refers to financial assistance donated to school by individuals or
organizations.
• Other: refers to other income source which does not fit into the above
categories.

24. Expenditure by type: State school expenditure by type in dollars

• Teachers Salaries: refers to the amount of money spent for teachers’ salaries.
• Non-teaching Staff Salaries: refers to the amount of money spent on salaries for
all other school staff, excluding teachers.

• Books/Instructional Materials: refers to all expenses for books and instructional

materials.
• Equipment: refers to all expenses for equipment such as furniture, television,
and computer or any other durable items.
• Repair and Maintenance: refers to expenses for repairing and maintaining
school facilities.

• Communication: refers to expenditures for communication services such as

telephone, fax, internet service, and postal services.

• Utilities: refers to expenditures for utilities such as electricity, and water.

Supplies: refers to expenditures for all other school supplies not classified as

instructional supplies such as fuel, cleaning agents, and tissues.



Note: Upon completing the Annual School Survey, enter your name and date in the
space provided.

4




Annual School Survey

Purpose

The Palau Ministry of Education, in its effort to formalize an annual school report for all
schools within the Republic, has developed an Annual School Survey. The purpose of
this survey is to collect school data which will be used to compile a comprehensive
report on elementary and secondary education. Results of the survey will be made
available to school principals and administrators for planning and management purpose.
Data being collected through this survey are classified into the following categories:
school information, course information, personnel information, and plant and facilities.

School principals shall be responsible for completing the Annual School Survey to close
out this school year and for submitting it to the Division of School Management by
June11, 2004. Any questions regarding this survey can be directed to the Division of
Research and Evaluation at 488-2570.


Directions for Completing the Annual School Survey

Heading

• Fill in current school year on the line provided.

• Fill in the beginning and ending dates of current school year

School Information

1. Name of School: Write the full name of the school on the line provided.
2. Mailing Address: Write the mailing address of the school on the line provided.
3. School Principal: Write the full name of school principal on the line provided.
4. Contact Numbers: Write contact numbers for the school (telephone, fax, and email
address) on the lines provided.



5. School Type: Mark appropriate box to indicate school type.

1


• Public: refers to schools established and run by the government
• Religious Organization: refer to schools which are sponsored, owned, and
managed by religious organizations

• Private Enterprise: refers to schools solely owned and run by private authorities

• Other: refers to any type of school not mentioned above, (i.e. foreign school)

6. School Level: Mark appropriate box to indicate school level and circle corresponding

grade levels.


7. School Region: Mark appropriate box to indicate the location of the school.

• Central: refers to schools located in Koror and Airai

• Babeldaob: refers to schools located on Babeldaob, excluding Airai
• Outlying States: refers to schools located in Kayangel, Peleliu, Angaur, and

Southwest Islands

8. Class Session: Mark appropriate box to indicate daily class sessions
• Students attend classes full day: refers to all students attending classes in the
morning and the afternoon.
• Students attend split class sessions: refers to one portion of student population
attending classes in the morning while the other portion attends classes in the
afternoon.
• Fill in the number of classes taught per day on the line provided.

• Indicate the length of each class in minutes on the line provided.


Course Information


9. List all subjects taught by grade level:
• Note: indicate title of main textbook to show focus of subject taught if there isn’t
a specific course title.


Student Information

10. Students by age, grade, and gender:
• Fill in the number of all students (including those in Special Education) who are
enrolled in school by age, grade, and gender in appropriate cell.

11. Special Education students by grade and gender: For each grade, indicate the
number of students in Special Education Program.
• Full-time: refers to students who receive Special Education services in all
subjects.
• Part-time: refers to students who receive Special Education services for only
particular subjects, aside from their regular classes.

2


12. Repeaters by grade and gender: Fill in the number of students who repeated the
same grade as that of previous year.

13. Transfers by grade and gender: Indicate number of students who transferred to and
from other schools by grade and gender.

• Transfer Out: refers to students who transferred out to other schools

• Transfer In: refers to students who transferred in from other schools

14. Dropout/Withdrawal by grade and gender: Indicate number of students who dropped
out or withdrew from school during current school year.
• Dropout: refers to students who stopped coming to school or withdrew from
school due to academic failure
• Withdrawal: refers to students whose parents withdrew them from school for
valid reasons such as migration and illness.

15. Number of sections by grade: Indicate number of sections by grade levels

• Sections: refers to distinct classes or student groups within a grade level

16. Projected Enrollment for next school year: Indicate expected enrollment by grade
level for a next school year.



Personnel Information

17. School Personnel: Indicate total number and list all employees at school site by the
following: last name, first name, date of birth, position, highest level of educational
attainment, and years of experience at current position.

• Use additional sheets if needed.



Plant and Facilities

18. Number of school buildings: Indicate number of school buildings.

• School buildings: refers to all building structures belonging to the school.

19. Number of instructional facilities: Indicate number of instructional facilities available
at the school. If a certain type of facility is not available, write ‘0’.

20. Number of furniture and equipment: Indicate number of furniture and instructional
equipment available at the school. If a certain furniture or equipment is not available,
write ‘0’.


3

21. Number of other facilities: Indicate number of other facilities available at the school.
If a certain type of facility is not available, write ‘0’.

22. Availability of support services: Mark appropriate box to indicate support services
available at the school.



School Income

23. Income by source: State school income by source in dollars
• National Government: refers to funds allocated to school by the National
Government or the Ministry of Education

• State Government: refers to funds allocated to school by the State Government
• Sponsoring Organization: refers to funds allocated to school by the organization
sponsoring the school
• Student Fees: refers to income, collected by the school from students.
• PTA: refers to financial assistance contributed by Parents Teachers Association
or similar organization.
• School Fundraising: refers to income raised through fundraising activities
sponsored by the school.
• Donations: refers to financial assistance donated to school by individuals or
organizations.
• Other: refers to other income source which does not fit into the above
categories.

24. Expenditure by type: State school expenditure by type in dollars

• Teachers Salaries: refers to the amount of money spent for teachers’ salaries.
• Non-teaching Staff Salaries: refers to the amount of money spent on salaries for
all other school staff, excluding teachers.

• Books/Instructional Materials: refers to all expenses for books and instructional

materials.
• Equipment: refers to all expenses for equipment such as furniture, television,
and computer or any other durable items.
• Repair and Maintenance: refers to expenses for repairing and maintaining
school facilities.

• Communication: refers to expenditures for communication services such as

telephone, fax, internet service, and postal services.

• Utilities: refers to expenditures for utilities such as electricity, and water.

Supplies: refers to expenditures for all other school supplies not classified as

instructional supplies such as fuel, cleaning agents, and tissues.



Note: Upon completing the Annual School Survey, enter your name and date in the
space provided.

4

MINISTRY OF EDUCATION

STUDENT DATA COLLECTION AND UPDATES

OCTOBER 12, 2004



Item Type of Data
Person
Collection
Due Date
Updates
Collected By
#
Responsible
Instrument:
1. Student
School Principal
Registration
two weeks into
as needed
Division of Research &
Information
Form
a new school
Evaluation
year
(belechuus@co.palaumoe.net)
2. Current
School Principal
Enrollment
two weeks into
quarterly
Division of Research &
Enrollment
Forms
a new school
Evaluation
year
(vremoket@co.palaumoe.net)
3. Student
School Principals
Student
bi-weekly
bi-weekly
Division of Research &
Absenteeism
Absenteeism
Evaluation
Form
(lruluked@co.palaumoe.net)
4. Drop-Out, School Principals
Monthly
first monday of
monthly
Division of Research &
Withdraw,
Updates
the month
Evaluation
Expulsion
(belechuus@co.palaumoe.net)
5.
Promotion, School Principals
Monthly
first monday of
monthly
Division of Research &
Retention,
Updates
the month
Evaluation
Referral,
(belechuus@co.palaumoe.net)
Suspension
6. Student
School Principals
Monthly
first monday of
monthly
Division of Research &
Transfers
Updates
the month
Evaluation
(belechuus@co.palaumoe.net)
7. Student
School Principals
Monthly
first monday of
monthly
Division of Research &
Offenses
Updates
the month
Evaluation
(belechuus@co.palaumoe.net)
8. Quarterly School Principals
Quarterly
two weeks after
quarterly
Division of Research &
Grades
Grades
each quarter
Evaluation
Worksheet
(vremoket@co.palaumoe.net)


1

MINISTRY OF EDUCATION

DATA COLLECTION AND REPORTING

OCTOBER 12, 2004




Item
Person
Collection
Collected and
Type of
Type of Data
Due Date
Frequency
#
Responsible
Instrument:
Reported By:
Report
School Data;
contact information,
Annual
School
May each
Chief of Research
Statistics
Annual, every
1.
type of school,
School
Principals
year
& Evaluation
Yearbook
October
grade levels,
Survey
location
Course Information;
Annual
course offerings,
School
May each
Chief of Research
Statistics
Annual, every
2.
School
graduation
Principals
year
& Evaluation
Yearbook
October
Survey
requirements
Student Data;
enrollment
age, gender
special ed,
Annual
School
May each
Chief of Research
Statistics
Annual, every
3.
repeaters, transfer,
School
Principals
year
& Evaluation
Yearbook
October
withdraw, drop out,
Survey
sections by grade,
projected
enrollment

1

Item
Person
Collection
Collected and
Type of
Type of Data
Due Date
Frequency
#
Responsible
Instrument:
Reported By
Report
Personnel
Information;
name, date of birth,
Annual
School
May each
Chief of Research
Statistics
Annual, every
4.
gender, position,
School
Principals
year
& Evaluation
Yearbook
October
education level,
Survey
years of experience
@ current position
Plant & Facilities;
school bldgs.,
instructional
annual
School
May each
Chief of Research
Statistics
Annual, every
5.
facilities, furniture $
school
Principals
year
& Evaluation
Yearbook
October
equipment, other
survey
facilities, support
facilities
Income &
School
Expenditure;
annual
Principals,
May each
Chief of Research
Statistics
Annual, every
6.
source of income
school
Admin.
year
& Evaluation
Yearbook
October
and type of
survey
services
expenditure
two weeks
School
inventory
Chief of School
Inventory
7. General
Inventory
after end of
Annual
Principals
forms
Management
Report
school year
Annual for
two weeks
Class
Class Schedule,
elementary
School
Scheduling
into a new
Chief of School
Schedule,
8.
Teachers
schools and
Principals
table
school year or
Management
Teachers
Assignment
every semester
a semester
Assignment
for PHS
two weeks
Chief of
School
inventory
Inventory
9. Book
Inventor
y
after end of
Curriculum &
annual
Principals
forms
Report
school year
Instruction
Item Type of Data
Person
Collection
Due Date
Collected and
Type of
Frequency

2

# Responsible


Instrument
Reported By



Report
Student quarterly
Quarterly
two weeks
Teachers/
Chief of Research
quarterly
10. grades, attendance
grades
after each
quarterly
Principals
& Evaluation
student grades

worksheet
quarter
Chiefs,
Program activities
monthly
first friday of
MOE monthly
11.
Program
Director
monthly
and highlights
reports
the month
report
Coordinators
Admin.
MOE Financial
financial
Every 12th of
Administrative
financial
12.
Services
monthly
Reports
report
the month
Services Manager
report
Manager
School activities
and highlights
including classroom
observation,
School
monthly
first monday
Chief of School
first friday of the
13.
monthly report
contributions to
Principals
reports
of the month
Management
month
school, PTA
meetings, and
financial reports
School
Principals,
bi-weekly
Administrative
first friday of the
14. Bus
Data
bi-weekly
monthly report
Transport.
reports
Services Manager
month
Manager
School
Principals,
monthly
first monday
Chief of School
first friday of the
15. Library
use
monthly report
Public
reports
of the month
Management
month
Librarian
School
monthly
first monday
Chief of School
first friday of the
16. Computer lab use
monthly report
Principals
reports
of the month
Management
month
Item Type of Data
Person
Collection
Due Date
Collected and
Type of
Frequency

3

# Responsible


Instrument
Reported By



Report
School
Production Report;
bi-weekly
every other
Food Services
first friday of the
17.
Principals
monthly report
meal counts, menu
reports
friday
Manager
month

School
Food Services
monthly
1st workday
Food Services
first friday of the
18.
Principals
monthly report
Report
reports
of the month
Manager
month

Maintenance
Maintenance Needs
Supervisor,
monthly
first monday
Administrative
first friday of the
19. (costs and status of
monthly report
Computer
reports
of the month Services Manager
month
work orders)
Technicians
Chiefs,
Incidence
20. Incidence
Reports
Program
bi-weekly Director
-
-
Report
Coordinators,
School
Chief of School
Incidence
first friday of the
21. Incidence
Reports
Principals,
bi-weekly
Management,
monthly report
Report
month
other staff
other Supervisors
Student
Student
Student
School
22.
absenteeism
bi-weekly DRE absenteeism
quarterly
Absenteeism
Principals
form
report
School
Student
School Personnel
School
personnel
23.
bi-weekly DRE absenteeism
quarterly
Absenteeism
Principals
absenteeism
report
form
School
24. Personnel
timesheet
timesheet bi-weekly
DPM

bi-weekly
Principals
Chief of
monthly
first monday
first friday of the
25. Personnel
Actions
Personnel
DPM monthly
report
reports
of the month
month
Management
A separate table entitled, Student Data Collection and Updates, outlines a schedule for collecting and updating student data

throughout current school year.


4



Ministry of Education
Republic
of
Palau

Annual School Survey

School Year _______ From __________ To __________


School Information:

1. Name of School







2. Mailing Address




3. School Principal






4. Contact Numbers
Tel:
Fax:






email:

5. School Type


Put an ‘X’ mark to indicate
Public
agency responsible for

school operations
Religious Organization

Private Enterprise

Other

specify

6. School Level
Elementary (
K
1 2 3 4 5 6 7 8)

Put an ‘X’ mark where

Circle appropriate grade levels
appropriate

Other
(
K
1 2 3 4 5 6 7 8
)


Circle appropriate grade levels
Specify
7. School Region


Put an ‘X’ mark to indicate
Central
where school is located

Babeldaob

Specify State
Outlying State


Specify State

8. Class Session
Students attend classes full day

Put an ‘X’ mark where

appropriate
Students attend split class session


Number of classes per day:
Length of each class:
MOE-0031A
Page 1 of 7
DRE 2/24/04

Course Information:

9. List all Book Titles by grade level. (Note: Use another sheet of paper if more than one title)

COURSES
GRADE 1
GRADE 2
GRADE 3
GRADE 4
English


Math


Science


Social
Studies


Palauan
Studies


Health


Physical
Education


Career
Guidance


Other (specify)




Other (specify)





COURSES
GRADE 5
GRADE 6
GRADE 7
GRADE 8
English


Math


Science


Social
Studies


Palauan
Studies


Health


Physical
Education


Career
Guidance


Other
(specify)


Other
(specify)




MOE-0031A
Page 2 of 7
DRE 2/24/04

Student Information:

10. Students by age, grade, and gender


Grade 1
Grade 2
Grade 3
Grade 4
Grade 5 Grade 6
Grade 7 Grade 8
Totals
(at Sept. 30th) M F M F M F M F M F M F M F M F M/F
Below 6

















6 years

















7 years

















8 years

















9 years

















10
years
11
years
12
years
13
years
Over
13
Total



11. Special Education students by grade and gender

Grade 1
Grade 2
Grade 3
Grade 4
Grade 5 Grade 6
Grade 7 Grade 8
Totals

M F M F M F M F M F M F M F M F M/F
Full Time

















Part Time



















12. Repeaters by Grade and Gender

Grade 1
Grade 2
Grade 3
Grade 4
Grade 5 Grade 6
Grade 7 Grade 8
Totals

M F M F M F M F M F M F M F M F M/F
Repeaters

MOE-0031A
Page 3 of 7
DRE 2/24/04


13. Transfers by grade and gender

Grade 1
Grade 2
Grade 3
Grade 4
Grade 5 Grade 6
Grade 7 Grade 8
Totals

M F M F M F M F M F M F M F M F M/F
Transfer

















Out
Transfer

















In


14. Dropout/Withdrawal by grade and gender

Grade 1
Grade 2
Grade 3
Grade 4
Grade 5 Grade 6
Grade 7 Grade 8
Totals


M F M F M F M F M F M F M F M F M/F
Dropout
Withdraw



















15. Number of sections by grade


Grade 1
Grade 2
Grade 3
Grade 4
Grade 5 Grade 6
Grade 7 Grade 8
Totals
Sections











16. Projected enrollment for next school year


Grade 1
Grade 2
Grade 3
Grade 4
Grade 5 Grade 6
Grade 7 Grade 8
Totals
No. of









Students


MOE-0031A
Page 4 of 7
DRE 2/24/04

Personnel Information:

17. School Personnel
Total: _______







Years of
Last Name First Name
DOB
Gender
Position
Education
experience @
Level
current
position






















































































































































































MOE-0031A
Page 5 of 7
DRE 2/24/04

Personnel Information:

School Personnel
continued (use additional sheets if needed)

Last Name First Name
DOB
Gender
Position
Education
Years of
Level
experience @
current
position





























































































































































































MOE-0031A
Page 6 of 7
DRE 2/24/04


Plant and Facilities:

18. Number of School buildings
21. Number of other facilities

______ School Buildings

_____ Office Space


_____ Teachers’ Office
19. Number of instructional facilities
_____
Cafeteria

______ Regular Classroom

_____ Health Clinic

______ Special Ed. Classroom

_____ Flush Toilet

______ Computer Lab
_____
Store
Room
______
Library

_____ Conference Room

______ Other ___________________

_____ __________________


_____ __________________
20. Number of furniture and instructional equipment

____ Student Desks
____ Infocus Projector
22. Availability of support services
____ Student Chairs
____ Television

mark ‘X’ to indicate availability
____ Student Desk-combo
____ Tape Recorder
Tutoring
Services
____ Teachers Desks
____ Laser Disc Players

____ Teachers Chairs
____ Video Player

Student Lunch Program
____ Classroom Worktables
____ Video Camera

____ Chalkboard/Markerboard ____ Camera
Bus
Transportation
____ Computers
____ PA System

____ Printers
____ Overhead Projector
Others
________________
____ Xerox Machine


specify


School Income and Expenditure for Previous Budget Year:


23. Income by source (in dollars)
24. Expenditure by type (in dollars)


National Government

Teachers Salaries

State Government

Non-Teaching Staff Salaries

Sponsoring Organization
Books/Instructional Materials

Student Fees

Equipment

PTA

Repair and Maintenance

School Fundraising

Communication

Donations

Utilities

Others ______________
Supplies

Total Income

Total Expenditure





Prepared by:
Date:


MOE-0031A
Page 7 of 7
DRE 2/24/04



Ministry of Education
Republic
of
Palau

Annual School Survey

School Year _______ From __________ To __________


School Information:

1. Name of School







2. Mailing Address




3. School Principal






4. Contact Numbers
Tel:
Fax:






Email:

5. School Type


Put an ‘X’ mark to indicate
Public
agency responsible for

school operations
Religious Organization

Private Enterprise

Other

specify
6. School Level


Put an ‘X’ mark where
Secondary
(
7 8 9 10 11
12
)
appropriate

circle appropriate grade
Other
( 7 8 9 10 11 12 )

s
pecify
circle appropriate grade

7. School Region


Put an ‘X’ mark to indicate
Central
where school is located

Babeldaob
specify
state
Outlying State
specify
state
8. Class Session
Students attend classes full day

Put an ‘X’ mark where

appropriate
Students attend split class session

Number of classes per day:
Length of each class:

MOE-0031B
Page 1 of 7
DRE 2/24/04

Course Information:

9. List all courses by grade level and indicate graduation requirements with asterisk (*).

COURSES
GRADE 7
GRADE 8
English

Math

Science

Social Studies


Palauan Studies


Vocational Course


Other (specify)


Other (specify)



COURSES
GRADE 9
GRADE 10
English

Math

Science

Social Studies


Palauan Studies


Health

Physical Education


Vocational Course


Other (specify)


Other (specify)



COURSES
GRADE 11
GRADE 12
English

Math

Science

Social Studies


Palauan Studies


Health

Physical Education


Vocational Course


Other (specify)


Other (specify)






MOE-0031B
Page 2 of 7
DRE 2/24/04


Student Information:

10. Students by age, grade, and gender

Age
Grade 7
Grade 8
Grade 9
Grade 10 Grade 11 Grade 12
Totals
(at Sept. 30th)
M F M F M F M F M
F M F M/F
Below 13













13 Years













14 Years













15 Years













16 Years













17 Years













18 Years













Over 18













Total
















11.Special Education students by grade and gender


Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Totals

M F M F M F M F M F M F M/F
Full Time













Students
Part Time













Students


12. Repeaters by Grade and Gender


Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Totals

M F M F M F M F M F M F M/F
Repeaters



















MOE-0031B
Page 3 of 7
DRE 2/24/04




13. Transfers by grade and gender



Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Totals

M F M F M F M F M F M F M/F
Transfer













Out
Transfer













In


14. Dropout/Withdrawal by grade and gender



Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Totals

M F M F M F M F M F M F M/F
Dropout

Withdrawal















15. Number of sections by grade


Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Totals

Section





16. Projected enrollment for next school year


Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Totals

No. of







Students








MOE-0031B
Page 4 of 7
DRE 2/24/04


Personnel Information:

17. School Personnel
Total: _______







Years of
Last Name First Name
DOB
Gender
Position
Education
experience @
Level
current position





























































































































































































MOE-0031B
Page 5 of 7
DRE 2/24/04


Personnel Information:

School Personnel
continued (use additional sheets if needed)







Years of
Last Name First Name
DOB
Gender
Position
Education
experience @
Level
current position





























































































































































































MOE-0031B
Page 6 of 7
DRE 2/24/04

Plant and Facilities:

18. Number of School buildings on campus
21. Number of other facilities

______ School Buildings

_____ Office Space


_____ Teachers’ Office
19. Number of instructional facilities
_____
Cafeteria

______ Regular Classroom

_____ Health Clinic

______ Special Ed. Classroom

_____ Flush Toilet

______ Computer Lab
_____
Store
Room
______
Library

_____ Conference Room

______ Other ___________________

_____ __________________


_____ __________________
20. Number of furniture and instructional equipment

____ Student Desks
____ Infocus Projector
22. Availability of support services
____ Student Chairs
____ Television

mark ‘X’ to indicate availability
____ Student Desk-combo
____ Tape Recorder
Tutoring
Services
____ Teachers Desks
____ Laser Disc Players

____ Teachers Chairs
____ Video Player

Student Lunch Program
____ Classroom Worktables
____ Video Camera

____ Chalkboard/Markerboard ____ Camera
Bus
Transportation
____ Computers
____ PA System

____ Printers
____ Overhead Projector
Others
________________
____ Xerox Machine


specify

School Income and Expenditure for Previous Budget Year:

23. Income by source (in dollars)
24. Expenditure by type (in dollars)


National Government

Teachers Salaries

State Government

Non-Teaching Staff Salaries

Sponsoring Organization
Books/Instructional Materials

Student Fees

Equipment

PTA

Repair and Maintenance

School Fundraising

Communication

Donations

Utilities

Others ______________
Supplies

specify


Total Expenditure


Total Income




Prepared by:
Date:


MOE-0031B
Page 7 of 7
DRE 2/24/04


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