Quiz on Forms and Reimbursement
HED 443s
1. Complete
form ISBE 34-02 for the following school and student and send your answers via
email to safety@siu.edu :
a.
Valmeyer High School, school code 0762, 618-935-2200,
valmeyer@valmeyer.k12.il.us
b.
Mary J. Smith, (BD) 2 February 1985
Joseph M. Brown, (BD) 12 December 1984
James R. Quick, (BD) 14 September 1984
Susan A. White, (BD) 12 November 1984
Charles E. Black, (BD) 1 January 1985
c.
-Smith and Black completed classroom 15 February 2001 on first attempt.
-Brown, Quick, and White completed classroom 15
December 2000 on first attempt.
-Smith and Black completed laboratory 1 April 2001
-Brown completed laboratory on second attempt 1
April 2001
-Quick and White completed laboratory 20 December
2000 on first attempt.
-White achieved proficiency after 3 hours of
laboratory.
2. Complete
ISBE form 54-30, given the following information.
a.
District 3, #0762, Valmeyer School System, Len Novara, Driver Education
teacher completing form, 618-935-2200, extension 120.
b.
No fees charged to students for DE program.
c.
One driver education teacher.
d.
Ύ (.75) teacher.
e.
1 classroom period of classroom instruction.
f.
5 periods of laboratory instruction.
g.
Instructor total salary (for all teaching) is $30,000; he received $600
for overtime teaching.
h.
Instructor total benefits (for all teaching) is $8,000.
i.
The school owns its own car which is used for Driver Education. Total cost of car was $18,000. Car is in second year of use.
j.
One classroom is used in new school (3 years of use). Cost of particular classroom was $48,000,
when constructed.
k.
One student received laboratory instruction at Waterloo High School at
cost of $210.
l.
No student received, no fees paid by other districts.
3. Describe (explain) the following status
code numbers that are used on ISBE form 34-02:
1
2
3
4
5
6
7
8
9 -
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