California Department of Education REQUEST FOR ALLOWANCE OF ATTENDANCE BECAUSE OF EMERGENCY CONDITIONS Form J-13A (Rev. 1- !

" School District (or Charter School) Name: School District (or Charter School) Address: Count -District Code: Count Name:

Form J-13A

!his form replaces the Form J-13A ("e#$ %-&') and should (e used to o(tain appro#al of attendance and instructional time credit under one or more of the follo)in* conditions: +hen one or more schools )ere closed (ecause of conditions descri(ed in Education Code Section %1%,, +hen one or more schools )ere -ept open (ut e.perienced a material decrease in attendance (ecause of conditions descri(ed in Education Code Section %/3&, +hen attendance records ha#e (een lost or destro ed as descri(ed in Education Code Section %/3&1

Appro#ed credit for instructional time ma (e used in con0unction )ith re*ular instructional da s to satisf the re1uirements of Education Code Section 32,', (e1ual len*th of instructional time amon* schools )ithin a district)$ A separate form should (e su(mitted for each emer*enc e#ent3 (ut credit ma (e re1uested for more than one school and under one or more of the fore*oin* conditions on the same form$ Each separate form must include the affida#it of the *o#ernin* (oard mem(ers and the count superintendent (efore it can (e appro#ed ( the State Superintendent of 4u(lic 5nstruction$ !he ori*inal form ()ith the (oard mem(ers6 affida#it) and t)o copies should (e filed )ith the count superintendent of schools$ 5f the count superintendent appro#es the re1uest3 he or she should e.ecute the affida#it certif in* that appro#al and for)ard all pa*es of the ori*inal and one cop of the form to: 7ffice of 4rincipal Apportionment and Special Education School Fiscal Ser#ices Di#ision California Department of Education 1%3' N Street3 Suite 38'' Sacramento3 CA &981%
!his form consists of fi#e preprinted pa*es$ 4a*es 1 and 9 (9C for charter schools) must accompan all su(missions$ 4a*e % (:ost or Destro ed Attendance "ecords) )ill not need to (e su(mitted ( most districts$ ;ultiple copies of 4a*es , and<or 3 ma ha#e to (e su(mitted )hen claims are made on a school-( -school (asis$

4a*e 1

California Department of Education SC#OOL CLOSURE Nature of Emer*enc (descri(e):

Form J-13A

Name of School(s): (if re1uest co#ers all schools3 )rite =all schools=)

School Code(s): +e re1uest that apportionments (e maintained and instructional time credited for the a(o#e named school(s) )ithout re*ard to the fact that the school(s) )ere closed on (dates):

(ecause of the descri(ed emer*enc $ Appro#al of this re1uest authori>es the local educational a*enc to disre*ard these da s in the computation of a#era*e dail attendance (ADA) (per Section %1%,,) and o(tain credit for instructional time for the da s and the instructional minutes that )ould ha#e (een re*ularl offered on those da s pursuant to Education Code Section %/,''3 et se1$ 5f the school closure resulted from a po)er outa*e or impassa(le roads caused ( inclement )eather3 state the num(er of school closure da s for the same conditions in each of the last fi#e ears:

4a*e ,

California Department of Education MATERIAL DECREASE Nature of Emer*enc (descri(e):

Form J-13A

Name of School: (if re1uest co#ers all schools3 )rite =all schools=) School Code(s): +e re1uest the su(stitution of estimated da s of attendance for actual da s of attendance in accordance )ith the pro#isions of Section %/3&,$ Appro#al of this re1uest )ill authori>e use of the estimated da s of attendance in the computation of apportionments for the fore*oin* school(s) for (dates) durin* )hich school attendance )as materiall decreased (ecause of the descri(ed emer*enc $ Estimated attendance for each da (7cto(er or ;a ADA): students per da $ Estimated dail attendance multiplied ( num(er of da s of material decrease3 ields da s of attendance re1uested$ State method of determinin* estimated dail attendance (7cto(er or ;a ADA): ADA for school month (e*innin* on 3, $ 3, and endin* on

Actual apportiona(le attendance for da s of material decrease: Site Date Actual Attendance

4a*e 3

California Department of Education LOST OR DESTROYED ATTENDANCE RECORDS

Form J-13A

+e re1uest the use of estimated attendance in lieu of attendance that cannot (e #erified (ecause of the loss or destruction of attendance records$ !his re1uest is made in accordance )ith Section %/3&1$ !he entire period co#ered ( the lost or destro ed records commences )ith 3, 3 up to and includin*3 3, $ Descri(e circumstances and e.tent of records loss or destruction:

Descri(e ho) it is proposed to reconstruct attendance records or estimate attendance in the a(sence of records:

4a*e %

California Department of Education AFFIDA$IT OF GO$ERNING BOARD MEMBERS

Form J-13A

+e3 mem(ers constitutin* a ma0orit of the *o#ernin* (oard of the school district3 here( s)ear (or affirm) that the fore*oin* statements are true and are (ased on official district records$

4rinted Names

Si*natures

A% &e'(% ' m')or*%+ o, %-e mem.er( o, %-e /over0*0/ .o'r1 (-'&& e2e34%e %-*( ',,*1'v*%. Su(scri(ed and s)orn (or affirmed) (efore me3 this Si*nature3 !itle of Count 3 California da of 3, $

Contact<5ndi#idual responsi(le for preparin* this form: Name: 4hone: Fa. : !itle: E-mail:

AFFIDA$IT OF COUNTY SU5ERINTENDENT OF SC#OOLS !he information and statements contained in the fore*oin* re1uest are true and correct to the (est of m -no)led*e and (elief$ Si*nature3 Count Superintendent of Schools Date: Su(scri(ed and s)orn (or affirmed) (efore me3 this Si*nature3 !itle of Count 3 California da of 3, $

Contact<5ndi#idual responsi(le for preparin* this form: Name: 4hone: Fa. : !itle: E-mail:

4a*e 9

California Department of Education

Form J-13A

AFFIDA$IT OF C#ARTER SC#OOL GO$ERNING BOARD MEMBERS +e3 mem(ers constitutin* a ma0orit of the *o#ernin* (oard of the charter school3 here( s)ear (or affirm) that the fore*oin* statements are true and are (ased on official district records$

4rinted Names

Si*natures

A% &e'(% ' m')or*%+ o, %-e mem.er( o, %-e /over0*0/ .o'r1 (-'&& e2e34%e %-*( ',,*1'v*%. Su(scri(ed and s)orn (or affirmed) (efore me3 this Si*nature3 !itle of Count 3 California da of 3, $

Contact<5ndi#idual responsi(le for preparin* this form: Name: 4hone: Fa. : !itle: E-mail:

A66rov'& .+ S46er*0%e01e0% o, A4%-or*7e1 Lo3'& E143'%*o0'& A/e03+ (LEA" Si*nature3 !itle of (:EA)$ AFFIDA$IT OF COUNTY SU5ERINTENDENT OF SC#OOLS !he information and statements contained in the fore*oin* re1uest are true and correct to the (est of m -no)led*e and (elief$ Si*nature3 Count Superintendent of Schools Date: Su(scri(ed and s)orn (or affirmed) (efore me3 this Si*nature3 !itle of Count 3 California da of 3, $

Contact<5ndi#idual responsi(le for preparin* this form: Name: !itle: 4hone: Fa. : E-mail: 4a*e 9C