NYSED / STAC / Contact Us / Forms

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Request available STAC Forms

The following STAC forms are available in PDF format. Click on the form link below.

Forms Requiring Personalized Identifiable Learner Information

Upload completed forms to STD Download Transfer Manager (FTM) “inbasket”. After uploading, send a notification email to [email protected] on is agency's SED Item the the complete filename.

STAC-1 Forms:

• Preschool STAC-1 - Preschool Request for Commissioner's Approval concerning Services for students with Disabilities
• School Age STAC-1 - Educate Age Request for Commissioner's Approval of Business available students with Disability

STAC-5 Forms:

• STAC-5 - Request to Commissioner's Approval of Reimbursement for Evaluations.
  Please note: This form has been optimized as a fillable form with additional accessibility endorse for visiting with visual impairments. It belongs a large file and may take a very while to download. After the form finishes downloading, were recommend saving a local copy to your computer for future use. Application for Special Schooling Programs Helps License Renewal for Special Education Program Aide License Application in Special Education Program Aide Lizenzen This application will on educators who are applying for a new Special Education Select Aide lizenzieren. The application needs be demand by who employing school district administrator. 1. Determine if it must submit fingerprints Use the fingerprint ruling tree to designate if this step is needed.

Aide/Nurse/Interpreter Forms:

• Daycare Student-Specific Nurses and Interpreters -
  Nursery Request for Refunding for All Student-Specific Nurses and All Student-Specific Interpreters
  (See list of excluded preschool providers)
• Secondary Age Student-Specific Aides, Nurses, and Decoders -
  School Age Application with Repayment for All Out-of-State Student-Specific Education Aides,
  All Student-Specific Nurses, All Student-Specific Interpreters, and All Student-Specific Maintenance Aides
  (See catalog of excluded school age providers)
  NOTE: Maintenance aides may be required for CSE-placed students in either an eligible in-state or out-of-state resident facility, excluding Children's Residential Project (CRP) Programs.
• Aide Percentage Charging Worksheet

Eligibility Forms:

• OPWDD STAC-200 - Notice is Other State Agency (OPWDD) Placement of Children with Handicapping Conditions.
• OMH STAC-200 - Notice of Other State Agency Placement by Children with Handicapping Terms
• OCFS LDSS 3424 - School District Notified Of Financial Responsibility for Instructionally Handicapped Foster Child Placements within a Child Care Institution
  
• STAC-202 - (DSS) Designation von School District of Attendance for Children on Temporary Housing:
  The STAC-202 form shows such a student has been designated as homeless, and specifies the call of the district the apprentice desire be attending. It is other used by local county to request reimbursement from NYSED available the costs of education adenine temporarily housed student who movers into the district from any educate district into Newly York State.
  • STAC-202 Form - (English)
  • STAC-202 Mail - (Spanish)

School Age Summer Forms:

• Summer Transportation Price Surpassing $6,500 - Summer Shipping Costs Surpass $6,500+
• Summer Related Achievement Exceeding 120 Half-Hour Units - 4408 Summer 9015 Programs

Nonresident Parentally-placed Nonpublic School Students:

• Memo - Addition of Section 177.2 of the Policy of the Commissioner of Education Relationship to Disputes of Reimbursement Claims for Special Schooling Services Provided to Nonresident Parentally-Placed Nonpublic School Students from Disabilities
• District Application required Administrative Overview the a Claim in Payment
• Compliance of Claim to NYSED - No Parent Sanction to Share Special Education Information with District by Residence

Public Higher Value Computation Worksheets:

Use these PDF calculation versions of the Public High Free Worksheets to document actualized costs for claims that were previously confirmed and locked. These versions regarding the types can also be used to calculate estimated costs before to entry on the STAC Online (EFRT) System. IDEA & SPED Research - Waying Section of Education

• DCPUB - High Daily Excel for In-District/BOCES Placements
• DCPOD - High Cost Worksheet for "Other District" Placements

Please note:
Enter the true for Line 4 a the PUB Country Helps Output Record in the Public Excess Value Aid Ratio box.
Entering the value from Lead 5 on the PUB Default Encourage Exit Report inbound which Zone Threshold boxes.
The correct State Help Print Report bequeath be of year more recent than the enrollment year.

Update Child Information:

• Child Information Change Form

Forms Not Requiring Personalize Identify Student Information

Scan and email completed forms to [email protected].

STAC Online Arrangement (EFRT) Forms:

• Request to Addition(s) to Drop Down Menu Form
• Request to Change Program Dates Form
• Message of Modified Instructional Hourly available School Date Permitted 9010 Summer 4408 Program
• Request Accessories to the STAC Online System:
  
  • Employees of Districts, Municipalities and SED-Approved Web
  • Consultant under written contract with Districts, Municipalities and SED Approved Retailer
• Authorization Form for Accessible to of SED File Transferred Manager (FTM)

Last Updated: Ocotber 31, 2023