BPSS - FINANCIAL STATEMENT SUMMARY WORKSHEET (must be completed and signed by the external auditor/accountant who audited/reviewed the school’s financial statements for the reporting period) Section 126.1(o) of the Commissioner's Regulations: “Gross tuition means all revenues received for instruction by or on behalf of the student, prior to any refund, from all sources, including but not limited to, lending institutions, Federal agencies, State agencies, and any other entity or organization. Gross tuition shall not include income from registration fees, the sale of books, supplies, services, kits, uniforms or equipment.” When reporting the gross tuition, you must include all funds received from ACCES-VR, WIA, DOL, etc. that were used to provide instruction to students. SCHOOL NAME & ADDRESS: ______________________________________________________ ______________________________________________________ ______________________________________________________ CORPORATE NAME: ___________________________________________________ SCHOOL DIRECTOR: NAME: ___________________________________ PHONE NUMBER: EMAIL ADDRESS: ________________________________________ _ _ _ - _ _ _ - _ _ _ _ SCHOOL SED CODE (12-digit): __ __ __ __ __ __ __ __ __ __ __ __ FISCAL YEAR REPORTING PERIOD: __ __ /__ __ /__ __ __ __ to __ __ /__ __ /__ __ __ __ For the FISCAL YEAR PERIOD above: Gross Tuition Income (GTI) = $ ____________________________ Page no. of income statement or supplementary schedule where tuition income clearly referenced: ___ Less: Student Refunds = $ ____________________________ Net Tuition Income = $ ____________________________ For the FISCAL YEAR PERIOD END DATE above: Tuitions Due and owing to past or presently enrolled students = $ _____________________ Page no. within financial statements where tuitions due and owing clearly referenced: ___ ATTACH ANY NECESSARY AUDITOR'S/ACCOUNTANT’S COMMENTS I attest that the gross tuition reported above is reflective of all income received on behalf of students, based upon the definition of gross tuition in accordance with the relevant provisions of the Education Law and the Commissioner's Regulations. SCHOOL DIRECTOR’S SIGNATURE: ________________________________________________DATE: _____________ INDEPENDENT AUDITOR’S or INDEPENDENT REVIEWER’S SIGNATURE: ________________________________________________DATE: _____________ NAME: _____________________________________________________ PHONE NUMBER: EMAIL ADDRESS: _________________________________________ _ _ _ - _ _ _ - _ _ _ _ FIRM NAME & ADDRESS: ___________________________________________ ___________________________________________ ___________________________________________ Mail this cover sheet and the required audited or reviewed financial statements to: New York State Education Department Bureau of Proprietary School Supervision 89 Washington Avenue, EBA 560 Albany, NY 12234 Revised 10/6/14 (revised 10/6/14)