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Forms

The Minnesota Department of Education is in the process of updating our forms to fillable PDF forms. Forms can then be filled out electronically and saved, or printed and filled out manually, if need be.

Some forms will be updated in the coming weeks; some will be kept as is until their next revision date. If you have questions about forms completion, please contact the person listed for each individual form.

Sort by Title, Due Date, Program Area, Charter School or Due Date by clicking on the heading below:

Title
Due Date
Contact
Program Area
Charter School
Form #
American Indian Education Transmittal Of Resolution and Parent Committee Roster
Form to be used by districts to formalize the formation of parent committees and document committee members.
2011-12-15Rebecca Garay-Heelan
651-582-8862		Adult Basic EducationYesED-02011-09
Application for an Addition to a Minnesota Education License (Teaching/Administrative/Related Services)
Use this form to add a field to an existing Minnesota license.
Nancy Farvour
651-582-8773		Educator LicensingYesED-02443-09
Application for Duplicate License
Use this form to obtain a duplicate of yoru license, return the completed application with the $1.00 processing fee.
Nancy Farvour
651-582-8773		Educator LicensingNoED-02352-10
Application for funds support services for deaf and hard-of-hearing adults
Use this form to request funds for interpreter and notetaker services for deaf and hard-of-hearing adults
Dan Smith
651-582-8330		Career and Technical Education01643-14
Application for Special Education Funds - Statement of Assurances
Michelle Jones
651-582-8577		School FinanceED-01350-29
Application for Voluntary Surrender of a Standard Education License (Teaching/Administrative/Related Services)
Use this form to surrender a Minnesota license.
Nancy Farvour
651-582-8773		Educator LicensingYesED-01695-09
Capital Equipment Expenditures - Request for Approval
Form to request approval for capital equipment expenditures to the 02 Fund (food service).
Debbie Firkus
651-582-8526		School Nutrition ProgramsYesED-02368-02
Capital Expenditure Disabled Access Revenue Levy Authority Application
Chris Kubesh
651-582-8319		School FinanceED-02081-20
Charter School Transportation Survey 2012-13 School Year
2012-03-01Kelly Wosika
651-582-8855		School FinanceYesED-02425-06
Child and Adult Care Food Program (CACFP) Agreement
Food and Nutrition Service
651-582-8698		Child/Adult Care ProgramsNoED-02409-04E
Child and Adult Care Food Program (CACFP) Center Application - FY2012
2012-06-30Food and Nutrition Service
651-582-8698		Child/Adult Care ProgramsYesED-02123-18E
Community Education Annual Report
An annual report for each school district having a community education levy.
Dan Smith
651-582-8330		00226-26
Concurrent Enrollment Program Aid Application
Form for qualifying districts to complete and apply for Concurrent Enrollment Program Aid.
2012-03-15Jessica Espinosa
651-582-8512		Career Tech Ed/Community Ed/Service LearningED-02456-01
County Auditor Report of School District Apportionment
Terri Yetter
651-582-8868		School FinanceED-00016-18
Determining Resident District
Barb Mattson
651-582-8767		School FinanceYesED-02457-01
District Revenues and Expenditures Budget for 2011-12
Sarah Miller
651-5828370		School FinanceED-000110-35
District-Owned School Bus Transaction
Kelly Wosika
651-582-8855		School FinanceED-00186-12
District-Owned Special Education School Bus Transaction
Kelly Wosika
651-582-8855		School FinanceED-02387-03
District-Owned Special Education Type III School Bus Transaction
Kelly Wosika
651-582-8855		School FinanceED-02388-03
District-Owned Type III School Bus Transaction
Kelly Wosika
651-582-8855		School FinanceED-01658-10
Early Childhood Family Education Annual Report (Worksheet)
The Early Childhood Family Education (ECFE) Annual Report form is a worksheet to prepare data for electronic submission to the Early Learning Services Data System. These data are about ECFE program particiaption and services during the school year.
2012-07-15Debbykay Peterson
651-582-8426		Early Childhood ServicesED-2309-12
Early Childhood Family Education Annual Report Worksheet (ED 01843-29)
The Early Childhood Family Education (ECFE)Annual Report is a worksheet to prepare data for electronic submission to the Early Learning Services Data System. These data are about ECFE program participation and services during the school year.
2012-07-15Debbykay Peterson
651-582-8426		Early Childhood ServicesNo01843-29
Early Childhood Family Education Participant Questionnaire Summary
Form to assist school districts in the preparation of aggregated Early Childhood Family Education participant demographic data for electronic submission to Minnesota Department of Education.
2012-07-15Debbykay Peterson
651-582-8426		Early Childhood ServicesED-2309-12
Early Childhood Family Education/School Readiness Participant Questionnaire
General demographic and related information for participation in Early Childhood Family Education (ECFE) and School Readiness programs. School districts collect and aggregate this data before submitting it to Minnesota Department of Education. These data helps the department improve program support to districts and outreach to families.
2012-07-15Debbykay Peterson
651-582-8426		Early Childhood ServicesED-2309-12
Early Childhood Screening Annual Report (Worksheet)
The Early Childhood Screening Annual Report form is a worksheet to prepare data for elctronic submission on the Early Childhood Screening program participation and services during the school year.
2012-07-15Debbykay Peterson
651-582-8426		Early Childhood ServicesED-2309-12
Early Graduation Achievement Scholarship and/or Military Service Award Programs Application
Form to be completed by the student who is interested in applying for an Early Graduation Achievement Scholarship and/or a Military Service Award.
Jessica Espinosa
651-582-8512		Career Tech Ed/Community Ed/Service LearningED-02463-03
English Learner Parent Notification - State
Sample letter districts send to notify parents of student placement into an ESL or Bilingual Education program
Anh Tran
Student Support Federal ProgramsYes02246-02E
Enrollment Options Program Limited Enrollment of Non-Resident Pupils Report
ED-02226-06
2012-07-15Cindy S. Jackson
651-582-8572		School ChoiceYesED-02226-06
Enrollment Projections Report - School Year 2011-12
For Charter Schools within their first three years of operation.
Jeanne Krile
651-582-8637		School FinanceYesED-02158-19
Enrollment Projections Report - School Year 2012-13
For Charter Schools within their first three years of operation.
Jeanne Krile
651-582-8637		School FinanceYesED-02158-20
Enrollment Projections Report - School Year 2013-14
For Charter Schools within their first three years of operation.
Jeanne Krile
651-582-8637		School FinanceYesED-02158-21
General Expenditure Worksheet II-B Special Education Personnel and Expenditures
Mike Matlock
651-582-8379		School FinanceED-01483-15
Home Language Questionnaire
Sample questionnaire in English. For the questionnaire in languages other than English, please contact mde.el@state.mn.us
Anh Tran
YesED-01336-08E
Homeschool Full Report
This form is to be printed and filled out or submitted electronically to resident school superintendents by October 1 of each year, or within 15 days of withdrawing a child from public school in order to homeschool.
2012-10-01Cindy S. Jackson
651-582-8572		Equity & InnovationNo
Interscholastic and Intramural Athletic Activities Worksheet
This form is used to report male and female elementary and secondary athletic activities information as required by Minnesota Rules, Part 3535.3600. For district files only. Do not return to MDE.
2011-10-15Sara Winter
651-582-8237		Compliance & MonitoringYesED-02307-02
Letter of Intent to Continue Homeschooling
This form is to be printed and filled out or submitted electronically to the resident school superintendent by October 1 of each year after the instructor has provided the same district with a Full Report.
2012-10-01Cindy S. Jackson
651-582-8572		Equity & InnovationNo
Milk Programs Application (New Sponsors) for FY2012
July 2011 - June 2012 paper application for new sponsors
2012-06-30Food and Nutrition Service
651-582-8698		Program Applications & USDA FoodsYesED-02123-18E
Online Learning Program Annual Update
Annual update form for approved online learning providers to complete and submit to MDE by July 13, 2012.
2012-07-13Deborah W. Proctor, Ph.D.
651-582-8328		Hg Sch/DualCred/Alt/OnlineLrng02444-04
Open Enrollment and Charter School Enrollment Programs Application for Student Transportation Reimbursement
Kelly Wosika
651-582-8855		School FinanceED-01875-13
Open Enrollment and Charter School Enrollment Programs Monthly Transportation Reimbursement Request
Kelly Wosika
651-582-8855		School FinanceED-01876-22
Open Enrollment and Charter School Enrollment Programs Student Transportation Reimbursement Report
Kelly Wosika
651-582-8855		School FinanceED-01877-12
Parent Committee Resolution Form
Form that may be used when writing a resolution to form an American Indian Parent Committee for the 2011-2012 school year.
2011-12-15Rebecca Garay-Heelan
651-582-8862		Equity & InnovationYes
Postsecondary Enrollment Options Program Application for Student Transportation Reimbursement
Kelly Wosika
651-582-8855		School FinanceED-01766-11
Postsecondary Enrollment Options Program Monthly Transportation Reimbursement Request
Kelly Wosika
651-582-8855		School FinanceED-01765-25
Postsecondary Enrollment Options Program Notice of Student Registration
Form to be completed providing notice of student registration in Postsecondary enrollment options program.
Steve Etheridge
651-582-8771		School FinanceED-01763-12
Postsecondary Enrollment Options Program Student Transportation Reimbursement Report
Kelly Wosika
651-582-8855		School FinanceED-01769-12
Pupil Transportation Annual Report
Kelly Wosika
651-582-8855		School FinanceED-01652-31
Qualified Zone Academy Bond Program Application
Chris Kubesh
651-582-8319		School FinanceED-02243-04
Reallocation of Federal Special Education Funds
George Holt
651-582-8889		School FinanceED-02465-01
Request for a Personnel Variance
Nancy Farvour
651-582-8773		Educator LicensingYesED-00330-24
Request for Fund Transfer
Guidance for transfer of funds under Laws 2011, 1st Special Session, Chapter 11, Article 5, Section 11
Lisa DeRemee
651-582-8467		School FinanceED-02462-01
Request for FY 2013 Coordinated Early Intervening Services (CEIS)
Michelle Jones
651-582-8577		School FinanceED-02466-01
Request for FY 2013 Federal Funds for Special Education Tuition Adjustment
Michelle Jones
651-582-8577		School FinanceED-02448-04
Request for Licensure Waiver to Facilitate Delivery of an Innovative Program/Teaching Assignment
Form and Guidelines for districts applying for a teacher to teach outside of his or her licensure area(s) on a waiver (Minn. Stat. 122A.09, Subd. 10)Please read the guidelines before completing the form.
Heather Ward
651-582-8213		Board of TeachingYesED-02373-04
Request for Permission to Hire a Non-licensed Community Expert
Form and guidelines for districts applying for a non-licensed individual to teach when a licensed teacher is not available (Minn. Stat. 122A.25). Please read the guidelines before completing the form.
Heather Ward
651-582-8213		Board of TeachingYesED-02396-01
Request for Reversal of a SERVS Transaction
Download this Excel Spreadsheet to to correct cleared reimbursement request transactions in SERVS Financial
Al Louismet
651-582-8500		Agency Finance& OperationsYesED-02454-01
Request to Appeal Personnel Variance
Form to request an additional year on a personnel variance for an individual who needs one more year to complete licensure. This form can be filled out online and mailed or faxed to the Board of Teaching.
Heather Ward
651-582-8213		Board of TeachingYesED-02344-03
Request to Appeal Temporary Limited License
Form to request an additional year on a limited license for an individual who needs one more year to complete licensure. This form can be filled out online and mailed or faxed to the Board of Teaching.
Heather Ward
651-582-8213		Board of TeachingYesED-02343-01
School District Credit Enhancement Application for Program Participation
Sarah Miller
651-5828370		School FinanceED-02110-05
School Nutrition Programs (SNP) Application - FY2012
July 2011 - June 2012 paper application for new sponsors
2012-06-30Food and Nutrition Service
651-582-8698		School Nutrition ProgramsYesED-02123-18E
School Readiness Annual Report (Worksheet)
The School Readiness Annual Report form is a worksheet to prepare data for electronic submission to the Early Learning Services Data System. These data are about School Readiness program participation and services during the school year.
2012-07-15Debbykay Peterson
651-582-8426		Early Childhood ServicesED-2309-12
School Readiness Participant Questionnaire Summary
Form to assist school districts in the preparation of aggregated School Readiness participant demographic data for electronic submission to Minnesota Department of Education.
2012-07-15Debbykay Peterson
651-582-8426		Early Childhood ServicesED-2309-12
School Readiness Program Plan (2012)
School Readiness Program Plans are required to be submitted biennially by school districts to the Minnesota Department of Education. The Plan describes how a program meets School Readiness program requirements.
2012-04-01Dr. Michael Brown
651-582-8399		Early Childhood ServicesED-02353-07
School Readiness Program Plan (Worksheet)
Guidelines and worksheet forms to prepare data for electronic submission. The school Readiness Program Plan is required for school districts to receive School Readiness Aid.
2012-07-15Debbykay Peterson
651-582-8426		Early Childhood ServicesED-2309-12
School Tax Abatement Report for Calendar Year 2011
Due February 1, 2012
Terri Yetter
651-582-8868		School FinanceED-02009-23
School Tax Abatement Six-Month Supplemental Report
Terri Yetter
651-582-8868		School FinanceED-02124-18
School Tax Report - 2011 Payable 2012
Terri Yetter
651-582-8868		School FinanceED-00119-35
Secondary Career and Technical Education Program Approval Proposal
This Program Approval Proposal may be completed and submitted to Adult and Career Education at any time during the school year. The proposal will be reviewed by Minnesota State Rules and you will be notified of action taken.
Marlys Bucher
651-582-8315		Career Tech Ed/Community Ed/Service Learning02335-03
Secondary Career and Technical Education Program Approval Proposal for Youth with Disabilities
This program approval proposal may be completed and submitted to Adult and Career Education at any time during the school year. The proposal will be reviewed by Minnesota State Rules and you will be notified of action taken.
Marlys Bucher
651-582-8315		Career Tech Ed/Community Ed/Service LearningED-00381-15
Secondary Career and Technical Education Transition Disabled Equipment Approval Request.
This application provides for necessary equipment to develop occupational competencies in an approved instructional program for students with disabilities.
Al Hauge
651-582-8409		Career Tech Ed/Community Ed/Service LearningED-00365-17
Special Education Application Court Placed Non-Minnesota Residents With IEPs 2011-2012
(ED-02432)
George Holt
651-582-8889		School FinanceED-02432-06
Special Education Application Out-of-State Tuition for Minnesota Residents 2011-2012
(ED-02431)
George Holt
651-582-8889		School FinanceED-02431-06
Special Education Application Special Pupils With IEPs 2011-2012
(ED-02433)
George Holt
651-582-8889		School FinanceED-02433-06
Special Education Application Special Pupils Without IEPs 2011-2012
(ED-02434)
George Holt
651-582-8889		School FinanceED-02434-06
Special Expenditure Worksheet II-C Individual Student Placements
Mike Matlock
651-582-8379		School FinanceED-01483-15
Statewide Enrollment Options
Enrollment Options/Open Enrollment Form
2012-01-15Cindy S. Jackson
651-582-8572		School ChoiceYesED-01861-23
Summer Food Service Program Agreement
Agreement for sponsors of summer food service programs.
Jenny Butcher
651-582-8543		School Nutrition ProgramsNoED-02372-04E
Summer Food Service Program Application
2012-05-01Jenny Butcher
651-582-8543		School Nutrition ProgramsYesED-01838-25F
Supplemental Notice of Student Enrollment Form
Form for student to submit to register for a supplemental online learning course from a certified public school online learning provider.
Jacqui McKenzie
651-582-8852		Hg Sch/DualCred/Alt/OnlineLrng
Taconite Credit Report
Jan Carlson
651-582-8342		School FinanceED-02331-09
Title III Intent to Form a Consortium
This document must be completed and submitted to MDE by districts intending to form a Title III Consortium.

Transition Disabled Contracted Services Approval Request Form
Complete this report when funding is being requested for contracted services associated with a career and technical education (CTE) program for students with disabilities.
Al Hauge
651-582-8409		ED 01445
Transportation to Interdistrict Desegregation or Integration Schools or Programs
Kelly Wosika
651-582-8855		School FinanceED-02370-08
UFARS Code Request
Sarah Miller
651-582-8370		School FinanceED-02093-03
Uniform Tuition Billing One-to-One Services - 2011-2012 School Year
Jeanne Krile
651-582-8637		School FinanceED-02424-06
 
 
 
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  • Minnesota Department of Education