Do not submit this sample combined worksheet: you must complete the surveys online and submit signed verification reports for both projected and actual data by the due dates



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Attachment A, Memo No. 098-16

April 22, 2016





DO NOT SUBMIT THIS SAMPLE COMBINED WORKSHEET: YOU MUST COMPLETE THE SURVEYS ONLINE and SUBMIT SIGNED VERIFICATION REPORTS FOR BOTH PROJECTED AND ACTUAL DATA BY THE DUE DATES

Advanced Placement and International Baccalaureate Fee Payment Program

2015-2016
For each question, provide the aggregated data for all of the high schools in your division for this school year. Refer to the definitions as needed.
AP = Advanced Placement

IB = International Baccalaureate

Low-Income = A student is Low-Income if the student:

1. is eligible for free or reduced lunch, OR

2. receives assistance under Title IV of the Social Security Act, OR

3. is eligible for assistance under the Medicaid program, OR



4. is eligible for assistance under the Community Eligibility Provision (CEP) for the National School Lunch Program (NSLP).
School Division: _________________________________
Projected Student Enrollment Data (Due May 6, 2016)




  1. Check this box if your division has implemented a program that pays for all AP and IB tests. If the first box is checked, your division is not eligible for the AP/IB Test Fee Program. The funds provided by the AP/IB Test Fee Program are designed to supplement, not supplant, other federal, state, local, or private funds available to assist individuals identified as Low-Income in paying for AP and IB testing.







  1. Number of students identified as Low-Income who plan to take at least one AP test.







  1. Number of AP tests to be taken by students identified as Low-Income.




  1. Number of students identified as Low-Income who plan to take an IB test.




  1. Number of IB tests to be administered to students identified as Low-Income.



Actual Student Enrollment Data (Due Friday, June 10, 2016)




  1. Check this box if your division has implemented a program that pays for all AP and IB tests. If the first box is checked, your division is not eligible for the AP/IB Test Fee Program. The funds provided by the AP/IB Test Fee Program are designed to supplement, not supplant, other federal, state, local, or private funds available to assist individuals identified as Low-Income in paying for AP and IB testing.







  1. Number of students identified as Low-Income who took at least one AP test.







  1. Number of AP tests taken by students identified as Low-Income.




  1. Number of students identified as Low-Income who took an IB test.




  1. Number of IB tests administered to students identified as Low-Income.


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