{"text_format":"1","workbook":"xlsx","n_sheets":3,"sheets":["Related Service","Additional Support Costs","Extraordinary One-Time Costs"],"not_rendered":{"charts":0,"images":0,"macros":0,"external_links":1,"defined_names":39,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Related Service","index":0,"n_rows":130,"n_cols":7,"rows_kept":130,"cut":false,"hidden":false,"merged":[[77,2,77,4],[78,2,78,4],[90,2,90,4],[91,2,91,4],[101,2,101,4],[102,2,102,4],[50,2,50,4],[51,2,51,4],[62,2,62,4],[63,2,63,4],[74,2,74,4],[75,2,75,4],[48,0,53,1],[18,2,18,4],[19,2,19,4],[20,2,20,4],[21,2,21,4],[22,2,22,4],[34,2,34,4],[35,2,35,4],[37,2,37,4],[38,2,38,4],[124,0,127,1],[112,0,116,1],[99,0,105,1],[88,0,92,1],[103,2,103,4],[114,2,114,4],[115,2,115,4],[126,2,126,4],[128,0,128,1],[129,0,129,5],[117,0,117,1],[118,0,118,5],[122,0,122,1],[124,2,124,4],[125,2,125,4],[127,2,127,4],[106,0,106,1],[107,0,107,5],[110,0,110,1],[112,2,112,4],[113,2,113,4],[116,2,116,4],[93,0,93,1],[94,0,94,5],[97,0,97,1],[99,2,99,4],[100,2,100,4],[104,2,104,4],[105,2,105,4],[82,0,82,1],[83,0,83,5],[86,0,86,1],[88,2,88,4],[89,2,89,4],[92,2,92,4],[66,0,66,1],[67,0,67,5],[70,0,70,1],[72,0,81,1],[72,2,72,4],[73,2,73,4],[79,2,79,4],[80,2,80,4],[81,2,81,4],[76,2,76,4],[46,0,46,1],[48,2,48,4],[49,2,49,4],[58,0,58,1],[64,2,64,4],[65,2,65,4],[60,0,65,1],[30,0,30,1],[32,0,41,1],[32,2,32,4],[33,2,33,4],[40,2,40,4],[41,2,41,4],[42,0,42,1],[43,0,43,5],[53,2,53,4],[54,0,54,1],[55,0,55,5],[60,2,60,4],[61,2,61,4],[52,2,52,4],[36,2,36,4],[39,2,39,4],[26,0,26,1],[27,0,27,5],[14,0,14,1],[16,0,25,1],[16,2,16,4],[17,2,17,4],[23,2,23,4],[24,2,24,4],[25,2,25,4],[0,0,0,6],[1,0,1,6],[2,0,2,6],[5,1,5,3],[5,5,5,6],[7,1,12,4]]}
["New Jersey Department of Education - Division of Administration & Finance - Office of School Finance"]
["Application for Special Education Extraordinary Aid for Costs "]
["Related Service Costs"]
["(Revision 4/23/2021)"]
["4 digit School Dist Code"]
["Student Name",null,null,null,"NJ Smart code"]
[]
[null,"This worksheet is for the tracking of eligible related service costs beyond tuition, classroom or any other allowed cost not already included in costs for a specific placement but  paid for directly by the district of residence of a special education student.  This includes costs paid to the provider of the services or paid to another public school or a private school when the services are billed separately from tuition."]
[]
[]
[]
[]
[]
[]
["Therapy-OT, PT, Speech, etc."]
[]
["Therapies received by the student should be entered here.  Examples of therapies you might include are: Audiological Therapy, Audiologist, Audiology Services, Feeding Therapy, Music Therapy, Occupational Therapy (OT), Physical Therapy (PT), Sensory Integration Therapy, Speech, Vision Instruction Services, Vision Therapy, Visually Impaired Therapy",null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F17:F26)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Therapy-OT, PT, Speech, etc.\" "]
[]
[]
["Instructional aide, paraprofessional, etc."]
[]
["Costs for specialized instructional support received by student should be entered here such as 1:1 Aide, 1:1 Instruction  by dedicated staff, ABA Applied Behavior Analysis, APE Adapted Physical Education, Instructional Aide, Interpreter- Braillist, Multiple Disability Teacher, Paraprofessional, Personal Assistant, Shared Aide, Shared Paraprofessional, Sign Interpreter, TVI Teachers Of Visually Impaired DO NOT ENTER COSTS FOR TRANSPORTATON AIDES",null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F33:F42)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Instructional aide, paraprofessional, etc.\" "]
[]
[]
["Vision, auditory"]
[]
["Costs for vision and auditory services can be entered here.",null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,"Sum A thru J - The subtotal of Related Service costs is:",null,{"$f":"SUM(F49:F54)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Vision, auditory\" "]
[]
[]
["Interpreter"]
[]
["Interpreter services received by the student should be entered here.  ",null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F61:F66)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Interpreter\" "]
[]
[]
["Supplemental instruction"]
[]
["Costs for other instructional services not included above can be entered here such as AAC Augmentative and Alternative Communication,  Behavioral Intervention,  CBVI Commission For The Blind And Visually Impaired,  CVR=Center For Voc Rehabilitation ,  DTT Discrete Trial Teaching ,  Educational Interpreter,  Home Tutor,  ICR In Class Resource Provided At Additional Cost, ",null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F73:F82)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Supplemental instruction.\" "]
[]
[]
["Assistive technology"]
[]
["Costs for services related to  assistive technology  can be entered here ",null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F89:F93)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Assistive technology\" "]
[]
[]
["Nurse/Direct Care"]
[]
["Costs for medical care services received by the student can be entered here such as Nurse 1:1 Full Time, Nursing Coverage During School Day Additional To School Nurse, Oral Motor Feeding, Safety Supervision\nEXCEPT FOR a nurse who is only with the student during transportation.",null,"1:1 Nurse",null,null,0]
[null,null,"Nursing Coverage During School Day Additional To School Nurse",null,null,0]
[null,null,"Oral Motor Feeding",null,null,0]
[null,null,"Safety Supervision",null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F100:F106)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Nurse/Direct Care.\" "]
[]
[]
["Nurse on bus completing full day coverage"]
[]
["When either the IEP or a doctor's order attached to the IEP requires full day nursing coverage including during transportation and that coverage is billed separately from the school day coverage, enter those costs here.",null,"Nurse on bus completing full day coverage",null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F113:F117)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Nurse on bus completing full day coverage\" "]
[]
[]
[]
["Residential Cost separate from tuition"]
[]
["Enter residential costs billed separately here.",null,"Residential Costs",null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F125:F128)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Residential Cost separate from tuition\" "]

{"sheet":"Additional Support Costs","index":1,"n_rows":121,"n_cols":7,"rows_kept":121,"cut":false,"hidden":false,"merged":[[99,0,102,1],[119,0,119,1],[120,0,120,5],[103,0,103,1],[104,0,104,5],[107,0,107,1],[109,0,118,1],[109,2,109,4],[110,2,110,4],[113,2,113,4],[114,2,114,4],[115,2,115,4],[116,2,116,4],[93,0,93,1],[94,0,94,5],[97,0,97,1],[99,2,99,4],[100,2,100,4],[81,0,81,1],[83,0,92,1],[83,2,83,4],[84,2,84,4],[87,2,87,4],[88,2,88,4],[89,2,89,4],[90,2,90,4],[91,2,91,4],[60,2,60,4],[65,0,65,1],[67,0,76,1],[67,2,67,4],[70,2,70,4],[71,2,71,4],[72,2,72,4],[73,2,73,4],[74,2,74,4],[57,0,60,1],[57,2,57,4],[58,2,58,4],[59,2,59,4],[27,2,27,4],[29,2,29,4],[43,2,43,4],[44,2,44,4],[45,2,45,4],[46,2,46,4],[47,2,47,4],[55,0,55,1],[111,2,111,4],[112,2,112,4],[118,2,118,4],[117,2,117,4],[101,2,101,4],[102,2,102,4],[85,2,85,4],[86,2,86,4],[92,2,92,4],[78,0,78,5],[61,0,61,1],[62,0,62,5],[68,2,68,4],[69,2,69,4],[75,2,75,4],[76,2,76,4],[77,0,77,1],[51,0,51,1],[52,0,52,5],[39,0,39,1],[41,0,50,1],[41,2,41,4],[42,2,42,4],[48,2,48,4],[49,2,49,4],[50,2,50,4],[20,0,20,6],[25,0,34,1],[26,2,26,4],[32,2,32,4],[33,2,33,4],[35,0,35,1],[36,0,36,5],[23,0,23,1],[30,2,30,4],[31,2,31,4],[34,2,34,4],[25,2,25,4],[28,2,28,4],[15,1,15,5],[16,0,16,1],[16,2,16,4],[17,0,19,1],[17,2,17,4],[0,0,0,6],[1,0,1,6],[2,0,2,6],[5,1,5,3],[5,5,5,6],[7,1,12,4]]}
["New Jersey Department of Education - Division of Administration & Finance - Office of School Finance"]
["Application for Special Education Extraordinary Aid for Costs "]
["Additional Support Costs"]
["(Revision 4/23/2021)"]
["4 digit School Dist Code"]
["Student Name",null,null,null,"NJ Smart code"]
[]
[null,"This worksheet is for the tracking of eligible costs beyond tuition, classroom or any other allowed cost not already included in costs for a specific placement but  paid for directly by the district of residence of a special education student.  This includes costs paid to the provider of the services or paid to another public school or a private school when the services are billed separately from tuition."]
[]
[]
[]
[]
[]
[]
[]
["Add'l Support Costs*","These are costs to provide the services supplemental to student's education."]
["Remember: ",null,"Descriptions of Support services",null,null,"Est. Cost"]
["If no tuition is involved, you can enter the district average budgeted support costs from the support cost averages list here and in the space provided for \"Support Cost Average or Proration\" in the application.        ",null,"OUR DISTRICT AVERAGE RATE ESTIMATED FROM BUDGET (Full or prorated for partial year)",null,null,0]
[]
[]
["OR\nYou can itemize support costs below."]
[]
[]
["Case Management/Child Study Team"]
[]
["The eligible costs of child study team or case management services may be entered here. \nThis is limited to \n1) an out-of-district placement for district provided  services at additional cost or \n2) for an in-district student when classroom costs have been calculated, no tuition or budgetary cost average has been used and the average support cost has not been claimed.",null,"Child Study Team",null,null,0]
[null,null,"Case Management By District Staff",null,null,0]
[null,null,"Annual Review Meeting",null,null,0]
[null,null,"Home Program Coordinator",null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F26:F35)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Case Management/Child Study Team\" "]
[]
[]
["Counseling"]
[]
["Counseling and planning services not covered in Case Management or Child Study Team services may be entered here.",null,"AAC Augmentative Or Alternative Communication Training ",null,null,0]
[null,null,"Counseling ",null,null,0]
[null,null,"Parent Training ",null,null,0]
[null,null,"School Based Counseling",null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F42:F51)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Counseling\" "]
[]
[]
["Behaviorist"]
[]
["Costs for a Behaviorist may be entered here",null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F58:F61)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Behaviorist\" "]
[]
[]
["Evaluation"]
[]
["Costs of evaluations may be entered here. Such as:\nConsults related to Classroom Adaptations, Assistive Technology, Behavioral Issues, \nCPC (Comprehensive Preschool Program) Screenings, Classroom Observation/Record Review, Vocational Assessment, \nBilingual, Developmental, OT, PT, Psychiatric, Sign Language or Social Evaluations",null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F68:F77)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Evaluation\" "]
[]
[]
["Transitional Services"]
[]
["Costs related to transitional services may be entered here.",null,"Communication Life Skills",null,null,0]
[null,null,"Job Coach",null,null,0]
[null,null,"SLE (Structured Learning Experience) With Skills Trainer",null,null,0]
[null,null,"Social Skills",null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F84:F93)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Transitional Services.\" "]
[]
[]
["After school/extended day program"]
[]
["Costs for After school or extended day programs should be entered here ",null," After school",null,null,0]
[null,null,"extended day",null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F100:F103)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"After school/extended day program.\" "]
[]
[]
["Recurring Support Cost"]
[]
["Recurring Support Cost should be entered here ",null,"Braille Paper",null,null,0]
[null,null,"Communication Access Real Time Translation",null,null,0]
[null,null,"Resource Room",null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F110:F119)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR \"Recurring Support Cost\" "]

{"sheet":"Extraordinary One-Time Costs","index":2,"n_rows":72,"n_cols":7,"rows_kept":72,"cut":false,"hidden":false,"merged":[[68,2,68,4],[69,2,69,4],[70,0,70,1],[71,0,71,5],[16,0,20,1],[18,2,20,4],[27,0,30,1],[29,2,30,4],[56,2,56,4],[57,0,57,1],[58,0,58,5],[62,0,62,1],[63,0,69,1],[63,2,63,4],[64,2,64,4],[65,2,65,4],[66,2,66,4],[67,2,67,4],[44,0,44,1],[45,0,45,5],[49,0,49,1],[50,0,56,1],[50,2,50,4],[51,2,51,4],[52,2,52,4],[53,2,53,4],[54,2,54,4],[55,2,55,4],[31,0,31,1],[32,0,32,5],[36,0,36,1],[37,0,43,1],[37,2,37,4],[41,2,41,4],[42,2,42,4],[43,2,43,4],[21,0,21,1],[22,0,22,5],[26,0,26,1],[40,2,40,4],[15,0,15,1],[16,2,16,4],[17,2,17,4],[38,2,38,4],[39,2,39,4],[27,2,27,4],[28,2,28,4],[0,0,0,6],[1,0,1,6],[2,0,2,6],[5,1,5,3],[5,5,5,6],[7,1,12,4]]}
["New Jersey Department of Education - Division of Administration & Finance - Office of School Finance"]
["Application for Special Education Extraordinary Aid for Costs "]
["Extraordinary One-Time Costs"]
["(Revision 4/23/2021)"]
["4 digit School Dist Code"]
["Student Name",null,null,null,"NJ Smart code"]
[]
[null,"This worksheet is for the tracking of eligible costs beyond tuition, classroom or any other allowed cost not already included in costs for a specific placement but  paid for directly by the district of residence of a special education student.  This includes costs paid to the provider of the services or paid to another public school or a private school when the services are billed separately from tuition."]
[]
[]
[]
[]
[]
[]
[]
["Tuition Adjustment from 18-19 paid in FY21"]
["Tuition Adjustments from 18-19 school year paid in FY21 should be entered here.  Please see the Manual and the FAQ regarding the requirements for claiming these costs.",null,"Tuition Adjustment from 18-19 paid in FY21",null,null,0]
[null,null,null,null,null,0]
[]
[]
[]
[null,null,null,null,null,null,{"$f":"SUM(F17:F18)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR Tuition Adjustment from 18-19 paid in FY21"]
[]
[]
[]
["Tuition Adjustment from 19-20 paid in FY21"]
["Tuition Adjustments from 19-20 school year paid in FY21 should be entered here.  Please see the Manual and the FAQ regarding the requirements for claiming these costs.",null,"Tuition Adjustment from 19-20 paid in FY21",null,null,0]
[null,null,null,null,null,0]
[]
[]
[null,null,null,null,null,null,{"$f":"SUM(F28:F29)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR Tuition Adjustment from 19-20 paid in FY21"]
[]
[]
[]
["Specialized Equipment used only by student"]
["Enter costs for Specialized Equipment used only by student here",null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F38:F44)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR Specialized Equipment used only by student"]
[]
[]
[]
["Specialized material"]
["Enter costs for Specialized Material used only by student here.",null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F51:F57)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR Specialized material"]
[]
[]
[]
["Personal Assistive Technology"]
["Enter costs for Personal Assistive Technology used only by student here.",null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,0]
[null,null,null,null,null,null,{"$f":"SUM(F64:F70)","v":0}]
["IN THE APPLICATION FORM ENTER THIS AMOUNT IN THE SPACE PROVIDED FOR Personal Assistive Technology"]