Receivership Quarterly Report - Yonkers Public Schools · Receivership Quarterly Report – 2nd...
Transcript of Receivership Quarterly Report - Yonkers Public Schools · Receivership Quarterly Report – 2nd...
Receivership
Quarterly Report
2nd Quarter - November 1, 2015 to January 15, 2016
School School BEDS Code District Status (R/Y/G) SIG/SIF/SCEP Cohort
Scholastic Academy 18 662300-01-0018 Yonkers
Green SIG 6
Superintendent School Principal Additional District Personnel Responsible for Program Oversight and Report Validation
Grade Configuration
Number of Students
Dr. Edwin M. Quezada Dr. Valencia Brown-Wyatt
Dr. Manya C. Bouteneff Pre-K-8th 610
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
2 | P a g e
Executive Summary
Please provide a plain-language summary of the current reporting quarter in terms of implementing key strategies, engaging the community, enacting Receivership, and assessing Level 1 and Level 2 indicator data. The summary should be written in terms easily understood by the community-at-large. Please avoid terms and acronyms that are unfamiliar to the public, and limit the summary to no more than 500 words.
At Scholastic Academy, the Community Engagement Team (CET) continues to meet on a consistent basis. The team met in November to discuss our plan of
action based on the news that our level 1 and level 2 indicators of progress, including the ones we wrote, were approved by the State. During the month of
December and January, the CET team provided input on the Professional Development needs based on our indicators. Members from our team as well as
other teachers from our school community provided workshops on using data, Explicit Instruction, Thinking Maps, Positive Behavioral Intervention and
Supports (PBIS) and the Sheltered Instruction Observation Protocol (SIOP) for English Language Learners. We have also held parent-teacher conferences on
student progress, begun extended day learning, and held grade level meetings and after-school professional development workshops geared towards
improving student outcomes with the use of data.
Attention – This document is intended to be completed by the School Receiver and/or their designee and submitted electronically to [email protected]. It is a self-assessment of the implementation and outcome of key strategies related to Receivership, and as such should not be considered a formal evaluation on the part of the New York State Education Department. This document also serves as the Progress Review Report for schools receiving School Improvement Grant (SIG) or School Innovation Fund (SIF) funds. Additionally, this document serves as the quarterly reporting instrument for schools with School Comprehensive Education Plans (SCEP). The Quarterly Report in its entirety must be posted on the district web-site.
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
3 | P a g e
Part I – Demonstrable Improvement Indicators
LEVEL 1 – Indicators Please list the school’s Level 1 indicators below and discuss each with respect to the type, nature and analysis (as applicable) undertaken during the current reporting quarter, as well as necessary course-corrections. Indicate the current status of each indicator in terms of the likelihood of meeting the established targets for realizing Demonstrable Improvement.
Identify Indicator Status (R/Y/G)
Base-line Target Strategies Used to Meet the Progress Target Evidence of Progress Towards the Progress Target
# 1: Priority School make yearly progress
G N/A Make AYP
Professional Development Sessions include Thinking MAPS, Explicit Instruction, RTI.
Implementations of the above initiatives are based on the Fall MAP data. Progress will be monitored
through formal and informal assessments. Our Literacy and Numeracy Coach will provide job embedding coaching in Literacy and Math. In-
depth Professional Development opportunities, (1x a week) are provided on all initiatives on site
and off site. Grade-level weekly congruence meetings are conversations around best practices, cross curricular skills, and data. The school follows
the District-wide calendar of assessments.
MAP Assessment Fall to Winter Data Analysis reflects the following: Mathematics: We currently have data grades 2, 4-8 all grade levels have shown growth in their mean RIT. Kindergarten, 1st and 3rd grade still pending (Testing for this groups ends on Friday 2/12/16). Reading: Minimal growth was reflected in grades 6th-8th while grades 2, 4, 5 and 7 showed moderate growth. 2nd and 4th grade showed moderate growth in both areas of ELA/ Math. Language: Grades 4-8 all showed moderate growth. However the data has reflected that we need to provide an emphasis on writing across all grade levels. Our Morning and Saturday academy will address the deficits that will be identified based on the ELA and Math Mock Assessment that will be given in mid-February and March. In addition, we collect meeting agendas, and exit slips/feedback forms from all Professional Development sessions on the building-wide initiatives. Likelihood of meeting target: unknown
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
4 | P a g e
Identify Indicator Status (R/Y/G)
Base-line Target Strategies Used to Meet the Progress Target Evidence of Progress Towards the Progress Target
# 2: Plan for and implement Community School Model
G 13-14 Implementation plan targets met; needs assessment completed; engagement team meetings scheduled and are held on a monthly basis.
Community Engagement Team meetings are
scheduled and are held on a monthly basis.
Implementation plan targets met;
needs assessment completed; the
following initiatives continue to
operate on a consistent basis: Family
Welcome Center, Smile Dental
Program; ESL Classes for Parents and
the (Kids Achievement Program (KAP)
After school Program. Westchester
Jewish Community Services (WJCS) has
been identified as our mental health
resource provider for our families. In
addition, we hold monthly PTA
meetings.
Likelihood of meeting target: high
# 98: Chronic
Absenteeism
Y Baseline 2014-2015 70 of 613 students were chronically absent (18 days over the course of the year)
1% decrease Scholastic Academy has instituted the
following social/emotional supports: Family
Welcome Center (parental support),
Westchester Jewish Counseling Services
(social emotional well-being of our students
and their families will be coming soon - March
2016); Positive Behavior Intervention System
(paw bucks) to gain student buy-in relative to
behavior, academics, attendance and
uniforms.
62 or our 607 students are chronically
absent as of January 30, 2016 (10+ days
out of school thus far)
Likelihood of meeting target: fair
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
5 | P a g e
Identify Indicator Status (R/Y/G)
Base-line Target Strategies Used to Meet the Progress Target Evidence of Progress Towards the Progress Target
# 19: 3-8 Math
LEP Students
Level 2 and above
G 13-14 1% increase Strategies used for our LEP students are
implemented through the Sheltered
Instruction Observation Protocol (SIOP) for
English Language Learners. This model
focuses on instructional and learning
strategies that strengthen cognitive and meta-
cognitive abilities.
Our Winter MAP Math results for LEP
students indicate that there was
growth in Language between the fall
and winter RIT scores. Despite the
increase within language, there are
some minor deficits with reading
relative to the MAP scores. At the
conclusion of NYS MOCK ELA/Math
testing in March, we will be able to get
another perspective on data that
correlates with the NYS ELA/Math
exams.
The school has an enrollment of
380. The results of the students on
grade level for ELA Fall 2015
indicates: grade 3 = 25.6%, grade 4
= 31.7%, grade 5 = 29.2% and grade
6 = 23.8%; ELA Winter 2016 on
grade level indicates the following:
grade 3 = 9%, grade 4 = 29%, grade
5 = 22% and grade 6 = 15%.
Likelihood of meeting target: high
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
6 | P a g e
Local 10: ELA 1st/2nd
Grade Measurement
of Academic Progress,
Growth Projections
Y 2 % reduction
in the percent
of students
testing as Level
1 on MAP ELA
Professional Development Sessions include
Thinking MAPS, Explicit Instruction, RTI.
Implementations of the above initiatives are
based on the Fall MAP data. Progress will be
monitored through formal and informal
assessments. Our Literacy and Numeracy
Coach will provide job embedding coaching in
Literacy and Math. In-depth Professional
Development opportunities, (1x a week) are
provided on all initiatives on site and off site.
Grade level weekly congruence meetings are
conversations around best practices, cross
curricular skills, and data. The school follows
the District-wide calendar of assessments.
Our Winter MAP ELA results for 1st and
2nd grade indicate the following: The
Mean RIT for Reading in 1st Grade
showed a 7.8 point growth. This places
the students at an early 1st grade
reading level, which is moderate
growth from where they started at a
Kindergarten level of reading. There
was also a 7% reduction in the number
of students in the low average range
and an 8% increase in students in the
average range. Additionally, there was
a 1% student increase in the high
range. MAP scores indicate that their
area of strength is vocabulary usage
and functions. Results for 2nd grade
also indicate a 7.8 point growth in the
Mean RIT for Reading placing them at
an early 2nd instructional level. The
MAP testing shows the following areas
of strength: Foundational skills as well
as Language and Writing.
Likelihood of meeting target: good
Expected results for this phase of the project are fully met, work is on budget, and the school is fully implementing this strategy with impact.
Yellow Some barriers to implementation / outcomes / spending exist; with adaptation/correction school will be able to achieve desired results.
Red Major barriers to implementation / outcomes / spending encountered; results are at-risk of not being realized; major strategy adjustment is required.
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
7 | P a g e
LEVEL 2 Indicators Please list the school’s Level 2 indicators below and discuss each with respect to the type, nature and analysis (as applicable) undertaken during the current reporting quarter, as well as necessary course-corrections. Indicate the current status of each indicator in terms of the likelihood of meeting the established targets for realizing Demonstrable Improvement.
Identify Indicator Status (R/Y/G)
Base-line Target Strategies Used to Meet the Progress Target
Evidence of Progress Towards the Progress Target
# 6: Family and Community Engagement (DTSDE Tenet 6)
G 14-15 TBD The CET created informational Parent Surveys
and parent information sessions. We work
closely with our PTA to learn more about what
parents need from the school. Our Family
Welcome Center liaison informs the school
administration about needs she hears from
parents.
The CET informational session (75
parents)
Open house: Total of 275 parent
participation
Hispanic Heritage Day: 75 parents
Parent Workshops through Title 1 and
Title 3
PTA Sponsored Activities : Book fair
Community Parent Informational Session
on 1/27/16 entitled “Working Together
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
8 | P a g e
Helping Your Child at Home” at the
Riverfront Library. There were 15
parents, the Assistant Principal and the
ESL adult teacher from Scholastic
Academy in attendance. Our Family
Resource Center Coordinator continues
to service our parents around issues of
housing, employment. and continued
educational opportunities.
Likelihood of meeting target: high
Identify Indicator Status (R/Y/G)
Base-line Target Strategies Used to Meet the Progress Target
Evidence of Progress Towards the Progress Target
#94: Providing 200 Hours of Extended Day Learning Time (ELT)
G 13-14 N/A Student selection for ELT was based on data (MAP fall/winter). NYS Mock ELA/Math data will help us to target students who are mid-1's 2 & 3's during AM Academy and Saturday academy. The low 1's continue to receive Title I intervention services, child centered meetings are being held and 6-8 week intervention plans are put in place for the purpose of monitoring growth prior to CSE referrals. Please note that there are 17 CSE cases still pending from 2014.
To date we have held 6,412 hours of extended learning time (ELT) with 216 students from grades 2-8. Currently ELT is on Mondays (8th grade only) and Tuesdays and Thursdays for grades 2-8. Scholastic Academy will be expanding ELT to include mornings (3 days a week from 7:30-8:30 and Saturdays from 8:30-12:00 PM for grades 3-8 only). Content is in preparation for the NYS Math/ELA and Regents Exams.
Likelihood of meeting target: high
#96: Percent of Newly
Hired
G 13-14 90% New teachers are strongly encouraged to attend professional development opportunities geared toward elevating their instructional
Scholastic has 17 non-tenured teachers and they all received a satisfactory rating on their first formal observation for the
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
9 | P a g e
Teachers with State
Provided
Growth Ratings of
Effective or
above
practices. Additional support/mentoring is given from our Literacy and Numeracy Coach through push-in support, data analysis and strategy building through modeling and practicing the strategies that were recommended from administration and the coach. In depth Professional Development opportunities, (1x a week) will be provided on all initiatives on site and off site. Grade level weekly congruence meetings are reflective around conversations of best practices cross curricular and data. Recommended strategies include the creation of Thinking Maps from students, SIOP strategies, and explicit Instruction strategies.
2015-2016 school year. Their walkthrough evaluations have also been satisfactory. Likelihood of meeting target: high
Identify Indicator Status (R/Y/G)
Base-line Target Strategies Used to Meet the Progress Target
Evidence of Progress Towards the Progress Target
Local 8: ELA
6th/7th Grade
all Students
Level 2 and
Above
G 36.7% of
5th
graders
and
56.9% of
6th
graders
are at
Level 2
or above.
The
same
cohort is
being
37.7% of 6th
graders and
57.9% of 7th
graders are
at Level 2 or
above
Professional Development Sessions include
Thinking MAPS, Explicit Instruction, RTI.
Implementations of the above initiatives are
based on the Fall MAP data. Progress will be
monitored through formal and informal
assessments. Our Literacy and Numeracy Coach
will provide job embedding coaching in Literacy
and Math. In-depth Professional Development
opportunities, (1x a week) are provided on all
initiatives on site and off site. Grade level
weekly congruence meetings are conversations
around best practices, cross curricular skills,
and data. The school follows the District-wide
Our Winter MAP ELA results for 6th and
7th grade indicate moderate growth in
Mathematics and Language. There was
minimal growth in Reading specifically
noting fluctuation in the goal area of
literature. Within the 7th grade, the
winter data reflects an increase within
the average range in the Goal area of
Literature, 16% (increase from the fall).
Within the 6th grade, the winter data
reflects a significant increase in the high
average percentile range of 17%
(increase of 10% from the fall).
Additional pending data (Mock
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
10 | P a g e
followed. calendar of assessments.
ELA/Math) will be analyzed to deduce
common threads that need additional
support. Our data analysis also shows
that writing is a deficit that we plan to
target during our ELT.
Likelihood of meeting target: good
Local 9:
Math 7th and
8th Grade
Students
Level 3 and
Above
Green
5.6% of
7th
Graders
and 1.7%
of 8th
graders
at or
above
Level 3.
6.1% of 7th
Graders and
2.2% of 8th
graders at or
above Level
3.
Professional Development Sessions include Thinking MAPS, Explicit Instruction, RTI. Implementations of the above initiatives are based on the Fall MAP data. Progress will be monitored through formal and informal assessments. Our Literacy and Numeracy Coach will provide job embedding coaching in Literacy and Math. In-depth Professional Development opportunities, (1x a week) are provided on all initiatives on site and off site. Grade level weekly congruence meetings are conversations around best practices, cross curricular skills, and data. The school follows the District-wide calendar of assessments.
Our Winter MAP Math results for 7th and 8th grade indicate Within the 7th grade, there was significant increase within the average range/ High average/ High Range in the following Goal areas: Operations and Algebraic Thinking: 16% high average, 2% high percentile (5% increase from the fall); Real and Complex Number Systems: 15% Average and 5% high average (7% increase from the fall); Geometry : 33% average, and 13% high average (12% increase since the fall); Statistics and Probability: 18% average (7% increase since the fall). Within the 8th grade, there was a significant increase within the average/high average/high percentile range in the following Goal Areas: Operations and Algebraic Thinking: 28% average; 15% high Average and 7% in high percentile (5% increase since the
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
11 | P a g e
fall); Real and Complex number systems: 20% high average and 6% high percentage ( 5% increase since the fall); Geometry: 30% Average; 15% high average; 6% High percentage (6% increase since the fall); and Statistics and Probability: 19% Average and 17% high average (4% increase since the fall).
Likelihood of meeting target: good
Expected results for this phase of the project are fully met, work is on budget, and the school is fully implementing this strategy with impact.
Yellow Some barriers to implementation / outcomes / spending exist; with adaptation/correction school will be able to achieve desired results.
Red Major barriers to implementation / outcomes / spending encountered; results are at-risk of not being realized; major strategy adjustment is required.
Part II – Key Strategies
Key Strategies As applicable, identify any key strategies being implemented during the current reporting period that are not described above, but are embedded in the approved intervention plan/budget and instrumental in meeting projected school improvement outcomes.
List the Key Strategy from your approved Intervention Plan (SIG, SIF, SCEP or Out of Time).
Status of each strategy (R/Y/G)
Identify the evidence that supports your assessment of implementation/impact of key strategies, the connection to goals, and the likelihood of meeting targets set forth in the Intervention Plan.
1. Administer the Winter MAP exam G Assessing growth of students based upon the Fall and Winter MAP
administration. Specific report of MAP: Projected Proficiency.
Indicator Code: Local measurement # 10: ELA 1st and 2nd Grade Progress
Target: 1% reduction of Level 1 students for the 2015-2016 school year.
2. Extended Learning Time (Tuesdays and Thursdays)
AM and Saturday Academy : Start Date: End of
February
G Attendance Rosters, Measurement Intervention Form (MIT) Progress
Target 2015-2016: TBD
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
12 | P a g e
3. Under Making Yearly Progress, Literacy/Numeracy
coach provides job embedded coaching to all
teachers to improve teacher practice which will
impact student outcomes.
G Documentation for the 2015-2016: The Literacy/numeracy coach
schedule, agendas and evaluation forms, professional development
survey and end of the year survey.
3. Under the % of Newly Hired Teachers with State
Provided Growth Rating of Effective and above, non-
tenure teachers have taken on the initiative of
become reflective practitioners as they receive on-
going training in core curriculum areas and or
strategies.
G Documentation for 2015-2016: Attending district level trainings, turn-key
professional development, feedback from walkthrough and formal
observations
Green Expected results for this phase of the project are fully met, work is on budget, and the school is fully implementing this strategy with impact.
Yellow Some barriers to implementation / outcomes / spending exist; with adaptation/correction school will be able to achieve desired results.
Red Major barriers to implementation / outcomes / spending encountered; results are at-risk of not being realized; major strategy adjustment is required.
Part III – Community Engagement Team and Receivership Powers
Community Engagement Team (CET) Please provide information regarding the type, nature, frequency and outcomes of meetings held by the entire Community Engagement Team and/or sub-committees charged with addressing specific components of the Community Engagement Plan. Describe goals and outcomes of meetings and committee work in terms of Community Engagement Plan implementation, school support and dissemination of information.
Status (R/Y/G)
Analysis / Report Out
G CET Team meets on a monthly basis with an agenda to analyze progress towards goals that are outlined in the CEP Plan as well as the level 1 and level 2 indicators. The team members share their perspectives, provide recommendations and take ownership of selected duties to ensure group accountability.
Powers of the Receiver
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
13 | P a g e
Please provide information regarding efforts on the part of the School Receiver to utilize powers pursuant to section 100.19 of Commissioner’s Regulations pertaining to School Receivership. Describe goals and outcomes related to Receivership powers currently being utilized (or in the developmental phase) in terms of their implementation/development status and their impact.
Status Analysis / Report Out
Green
The Interim Superintendent of Schools / Receiver, Dr. Edwin Quezada has committed to the following goals:
A. Support a culture of continuous improvement using specific qualitative and quantitative measures: Specific Focus – Literacy B. Ensure that curriculum, instruction, staff development, supervision, and community engagement are clearly interconnected.
In order to achieve these goals, and meet the Indicators of Demonstrable Progress targets, the Interim Superintendent of Schools / Receiver has:
Goal A.
Allocated funding and negotiated with the teacher union to create a literacy/numeracy coach positions in all schools in receivership, with an additional bilingual coach for the 2 bilingual schools in receivership
Continued focused professional development on research-based strategies, including the 90/90/90 school research
Continued leadership professional development for all principals, with additional targeted sessions for principals of schools in receivership
Goal B.
Allocated funding and negotiated with the teacher union to provide 4 half-days (early release for students) of professional development for
teachers in schools in receivership
Provided additional supports for student and family social-emotional needs by increasing guidance staffing, and creating family welcome-center
liaison positions
Impact in the second quarter:
1. Culture increasingly focused on student achievement – natural conversations with administrators and teachers, as well as students reveal a more explicit focus on learning and achievement than seen previously
2. Increased collection and reporting on impact data to measure the effectiveness of programs and interventions, and to measure progress towards Indicators of Demonstrable Progress – agendas of teacher meetings, data walls in hallways and classrooms, and natural conversations with administrators, teachers and students demonstrate an increased reliance on data to both measure progress and target instruction.
Green Expected results for this phase of the project are fully met, work is on budget, and the school is fully implementing this strategy with impact.
Yellow Some barriers to implementation / outcomes / spending exist; with adaptation/correction school will be able to achieve desired results.
Red Major barriers to implementation / outcomes / spending encountered; results are at-risk of not being realized; major strategy adjustment is required.
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
14 | P a g e
Part IV – Best Practices (Optional)
Best Practices The New York State Education Department recognizes the importance of sharing best practices of schools and districts. Please take this opportunity to share one or more successful strategy currently being implemented in the school that has resulted in significant improvements in student performance, instructional practice, student/family engagement, and/or school climate. It is the intention of the Department to share these best practices with schools and districts in Receivership.
List the best practice currently being implemented in the school.
Describe the best practice in terms of the impact it is having, the evidence being collected to determine its value, and the manner in which it might be replicated in other schools/districts.
1. Thinking Maps The usage of Thinking Maps provides a way to gather and record information, analyze text and
organize thoughts in a more cohesive manner, which impacts student writing. Evidence:
Agendas, exit tickets, Examples of student created Maps and student writing across content
areas.
Impact Noted: Based on recent MAP administration, students have shown growth in the area
of Language Usage. Growth ranges from 2.6 points to 8 points in the Mean RIT for Language
across grades 4-8. Results for 2nd and 3rd are still pending.
2. Sheltered Instruction Observation Protocol (SIOP) Best practice for English Language Learners, which can be used with all students as it promotes
meaningful interaction, is accountable talk and the use of language across all content areas.
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
15 | P a g e
Evidence of implementation has been noted in agendas, exit tickets, feedback in observations
and formals.
Impact Noted: Teacher observations reflect the following: Implementation of SIOP Strategies
during lessons has increased the use of accountable talk among students.
3. Explicit Instruction Teacher modeling and scaffolding instruction gives students multiple opportunities to respond using various techniques and strategies. Members of the Quality Improvement Plan (QIP) Team meet with their coach on a monthly basis to review data collected regarding student engagement, higher order questioning and modifying instruction for students with IEP’s and at-risk learners. Evidence noted is through Quip plan, observations (Explicit Instruction Walkthrough Form, agendas and exit tickets.
Impact Noted: Teacher observations reflect the following: Teachers are using Explicit Instruction to plan lessons and model for students using the” I do, we do and you do” strategy. They also are using Explicit Instruction Strategies to increase student engagement resulting in students increasing their time on task.
4. Positive Behavior Intervention Supports (PBIS) Multi-tiered proactive and school-wide discipline program geared towards reducing incidences and increasing academic and behavior outcomes.
Evidence: Incident report forms, student behavioral form reflection sheets and suspension data.
Impact Noted: PBIS has increased positive behavior especially in our two intensive support classes which has resulted in a decrease of the number of suspensions in those classes. Suspensions have decreased building-wide.
Part V – Attestation ATTESTATION: By signing below, I certify that the information in this quarterly report is true and accurate to
the best of my knowledge.
Name of Receiver (Print): ___________________________________
Receivership Quarterly Report – 2nd
Quarter November 1, 2015 to January 15, 2016
(As required under Section 211-f(11) of NYS Ed. Law)
16 | P a g e
Signature of Receiver: _____________________________________
Date: ___________________________________________________