Form SFN60869 "School District Pre-kindergarten Program Approval" - North Dakota

What Is Form SFN60869?

This is a legal form that was released by the North Dakota Department of Public Instruction - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2020;
  • The latest edition provided by the North Dakota Department of Public Instruction;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN60869 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Public Instruction.

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Download Form SFN60869 "School District Pre-kindergarten Program Approval" - North Dakota

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SCHOOL DISTRICT PRE-KINDERGARTEN PROGRAM APPROVAL
ND
DEPARTMENT OF PUBLIC INSTRUCTION
STUDENT SUPPORT & INNOVATION DIVISION
SFN 60869 (1/2020)
School District
Program Name
Mailing Address
City
State
ZIP Code
Contact Person
Contact Person Email Address
Telephone Number
Fax Number
Check all boxes that apply
New Approval
Continuing Approval
Member of Early Childhood Coalition
Section A: Highly Qualified Teacher(s)
Name of Teacher
Teaching License Number
Name of Teacher
Teaching License Number
Name of Paraprofessional
Paraprofessional Number
Section B: Board Approval
The district/program must submit school board minutes reflecting approval of the pre-kindergarten grade configuration in the district.
Date of Board Approval
Date of Agency Approval
Section C: Fire Marshal Report
If the pre-kindergarten program is housed in a building outside of the K-12 buildings, the fire marshal report submitted must be that of the
pre-kindergarten building.
Date of the most recent fire and safety report by a fire marshal
Section D: Program Operations
Days per week
Hours per week
Section E: Assurances
Provide brief description for each.
Assurance that provider is willing to admit children of all learning abilities into the program.
Assurance of using the Pre-kindergarten Content Standards.
Assurance that program incorporates within its curriculum at least 10 hours of research-based parental involvement.
Assurance of using State Content Standards.
Section F: Funding Information
Please indicate the percentage of funding received from each source.
Title I
Local
Special Education
State
Donations
Other
Tuition
FOR DEPARTMENT USE ONLY
Signature
Date
SCHOOL DISTRICT PRE-KINDERGARTEN PROGRAM APPROVAL
ND
DEPARTMENT OF PUBLIC INSTRUCTION
STUDENT SUPPORT & INNOVATION DIVISION
SFN 60869 (1/2020)
School District
Program Name
Mailing Address
City
State
ZIP Code
Contact Person
Contact Person Email Address
Telephone Number
Fax Number
Check all boxes that apply
New Approval
Continuing Approval
Member of Early Childhood Coalition
Section A: Highly Qualified Teacher(s)
Name of Teacher
Teaching License Number
Name of Teacher
Teaching License Number
Name of Paraprofessional
Paraprofessional Number
Section B: Board Approval
The district/program must submit school board minutes reflecting approval of the pre-kindergarten grade configuration in the district.
Date of Board Approval
Date of Agency Approval
Section C: Fire Marshal Report
If the pre-kindergarten program is housed in a building outside of the K-12 buildings, the fire marshal report submitted must be that of the
pre-kindergarten building.
Date of the most recent fire and safety report by a fire marshal
Section D: Program Operations
Days per week
Hours per week
Section E: Assurances
Provide brief description for each.
Assurance that provider is willing to admit children of all learning abilities into the program.
Assurance of using the Pre-kindergarten Content Standards.
Assurance that program incorporates within its curriculum at least 10 hours of research-based parental involvement.
Assurance of using State Content Standards.
Section F: Funding Information
Please indicate the percentage of funding received from each source.
Title I
Local
Special Education
State
Donations
Other
Tuition
FOR DEPARTMENT USE ONLY
Signature
Date