Local School District Targeted Services Class Request

A separate request will need to be filled out for each targeted services class in your program.
Please return request to Brian Cashman, Innovative Programs Coordinator, at least one month prior to the start of
your Targeted Services class.

School District: Zumbrota Mazeppa Public Schools

School Site: Middle School in Zumbrota
Todays Date: October 7, 2015
Name of the Class: After School Study
Description of the Class (purpose, area(s) of focus): Following a short snack break students and teachers will
work together on both skill work in the areas of both math and reading, as well as development of study skills.
Goals for the Class: To increase basic skills as well as reduce missing work
Days of the Week: Tues. Thurs.
Class Date Range: Nov. 13 April 7
No Class Dates On: Nov 24; December 22-31; February 11; March 1 & 24
Total # of Sessions: 33
Time of Class: 7-8 = 60 minutes per session
Total Student Contact Hours: 7-8 = 33 hours
Approximate Amount of Students Per Grade: K____ 1-3__ 4-6__ 7-8_25_
A budget proposal is completed and attached _____Yes
Form Completed By: Wendy Ahern
Form Submitted By: Wendy Ahern
A copy of this form has been provided to:
Site Administrator____X__ District Business/HR Manager __X__

Local School District Targeted Services Budget Proposal

A separate proposal will need to be filled out for each targeted services class in your
program.
Attach this budget proposal with your class request form.

Date: October 7, 2015

School/Fiscal Year: 2015-2016
School District: Zumbrota Mazeppa Public Schools
School Site: Middle School in Zumbrota
Type of Budget: New__X__ Revised____
Class Name: After School Study
Completed By: Wendy Ahern
Projected Revenue
Grade
K
1-3
4-6
7-8

Total Hours

Enrolled Students

32

20

Hourly Rate
2.73
4.98
4.74
5.81

Projected Expenditures
Description
Instructors
Educational Assistants
Instructional Materials
Food
General Supplies

Estimated Amount
$33 per hour*total hours=$2640
$0
$0
$500
$0

Transportation
Projected Revenue Projected Expense = $578.00
3718.40 3140 = 578

Total Revenue

3,718.40