Page 135 - E-Rate 2020-21 Workbook

NON‐INSTRUCTIONAL FACILITY, SPECIAL PROGRAMS BLDG, & NEW CONSTRUCTION ‐ INSTRUCTIONS:

a. Sequential number for sites provided in this form, ATTACH ADDITIONAL PAGES IF
NECESSARY

b. Name of Site ‐ Provide the name of the building or site. Do NOT include your school or
library sites that are recognized by the state. Provide information on buildings that are
NOT already recognized by the state on accreditation reports or state library listings.

c. Enter "Owned" if this site is located on school or library property; enter "Leased" if the
site is leased
d. Address of Site

e. City of Site

f. Zip code of site
g. Description of activities and/or programs held at this site. Examples: Child Nutrition,
Transportation & Maintenance, Alternative Ed, Phys Ed

h. Opening Date- Please provide date this facility was opened or will be opened
i. Estimated # of Students

j. Effective Date for new use-Please provide date this site changed to the new program
and/or use listed on this form

k. Provide the main phone number associated with this site (do NOT provide the main
switchboard# but the direct phone number to this location)

l. Provide the main fax number associated with this site (only provide fax number for faxes
received at this location)
m. If this site is on the same campus as one of your sites listed with the state dept. of
education (NOT across a public roadway), please list the name of the adjacent site;
otherwise enter n/a. Example your Vo‐Ag building is next to your high school on the
same campus, list "HS"

n. Are classes held at this site? Please answer YES or NO

o. If ALL of the students come from the same site to this location, please provide the name
of the sending site. Example: Alternate Ed bldg that services only the students from the
HS, you would enter "HS”.

p. If the students come from various sites to this location, then enter "Various". Example:
Vo‐Ag bldg that services MS and HS students.

Questions? Contact Kellogg & Sovereign Consulting
Phone 580.332.1444
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