BPSS - FINANCIAL STATEMENT SUMMARY WORKSHEET

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)