Name of Grant Program: Competitive Academic Support Services
Work and Learning Programs
Fund Code: 597 (Summer)
PART III – REQUIRED PROGRAM INFORMATION
Application for Competitive FY2017 Summer Program Funds
Please provide the following information.
1. Applicant Name (District, College, or Organization):
2. Partner Name(s), if any:
3. High School(s) Served:
4. Program Coordinator:
5. Mailing Address:
6. Email Address:
7. Phone #:
Fax #:
8. TOTAL Funds Requested with this application proposal: $ _______
Projected Per Pupil Cost: $
(Funds Requested Divided by Total Number of Students) Note that the average per pupil cost in the past
several grant cycles has ranged from $1,000 to $1,500; requests in excess of that range will need significant
justification.)
9.
Unduplicated Count of Students: (total number of students proposed to be served)
10. Ratio of Students to Teachers:
11. Write a brief summary of the program(s) to be funded by this grant and include the location of
services.
Name of Grant Program: Competitive Academic Support Services
Work and Learning Programs
Fund Code: 597 (Summer)
12. Program Offerings, Schedule, and Number of Students proposed to be served in the summer.
[Note that this chart seeks information about academic support services only, question 15 below
requests information about work-based learning services for the students proposed to be served.]
PROGRAM TYPE
ENGLISH LANG. ARTS
MATHEMATICS
SCI. & TECH./ENG.
Summer Programs and
Services
Hrs/Day____
Hrs/Day____
Hrs/Day____
Underline/circle days
of the week program will meet:
Underline/circle days
of the week program will meet:
Underline/circle days
of the week program will meet:
Underline or Circle Class
Years
to be Served:
M
T
W Th Fr Sat Sun
M
T
W Th Fr Sat Sun
M
T
W Th Fr Sat Sun
Total Wks ___ / Total Hrs____
Total Wks ___ / Total Hrs____
Total Wks ___ / Total Hrs____
Start Date ______
Start Date ______
Start Date ______
End Date ______
End Date ______
End Date ______
Number of students
to be served: _____
Number of students
to be served: _____
Number of students
to be served: _____
TOTAL NUMBER STUDENTS
TO BE SERVED –
PER SUBJECT
(unduplicated Counts)
ELA:
Mathematics:
Sci.& Tech./Eng.:
TOTAL NUMBER TO BE
SERVED: (All subjects)
Unduplicated Count =
2003-2016 (post
12th)
2017
Please answer the following narrative questions (13-19),
using no more than seven (7) pages.
NARRATIVE QUESTIONS
13. Students to be served
a. Target Population: What group of students in need of academic support (beyond the programs and
services already available to them) will this proposed program serve?
b. Recruitment: Describe the recruitment strategies for students most in need of services. As a part of this
answer, describe how the program has purposefully considered the needs of and ensured access to
students who are English language learners, homeless, in alternative programs, and/or have disabilities or
behavioral health issues.
c.
Needs Analysis: Describe the knowledge and skills that the target population must acquire to meet the
competency determination in English language arts, mathematics, and Science and
Technology/Engineering.
Name of Grant Program: Competitive Academic Support Services
Work and Learning Programs
Fund Code: 597 (Summer)
14. Program Design
a. Program Location(s)/Learning Environments: Describe where the program will be offered, including both
the academic support and the work-based learning component, and how the intended learning environment
will enhance the likelihood of improved student attendance, engagement, and learning.
b.
Describe specific plans for the work-based learning component of the program, including where the
required internships will take place, who will arrange for the placements, and how students will be
prepared for their placements.
c.
Instructional models/approaches to be used in the program:

How will active, engaging, hands-on, and relevant curriculum in the tested areas of math, ELA and
Science and Technology/Engineering be incorporated into the program to address gaps in students’
knowledge and skills?

Describe ways that the required internship/work-based learning experience will be integrated with the
academic support aspect of the program, and how the program will make connections between the
academic portion and the students’ work experience.

How will the individual needs and performance gaps of students in the program be identified and
addressed, including any skill gaps in the foundation skills reflected in the MA Work-Based Learning
Plan?
d. How will students’ progress be assessed, both academically and with respect to use of the MA WBLP?
15. Continuity and Coordination of Instruction with School Year staff
a. How will the program instructors collaborate and communicate with school year staff to provide coherent
individualized instructional support in the summer?
b. Describe concrete ways that the program staff will convey information about any participants returning to
school in the fall to school year teachers, guidance counselors, and other programming.
16. Contextual Learning Website
a. Describe any lesson/project that you plan on using from the Contextual Learning Portal (CLP) website to
engage students in academic work applied to a real world context.
b. Describe your plans for contributing new projects and/or lessons to the portal as a result of your program.
17. Staffing
NOTE: Recipients of these grants must agree to provide staff who have subject matter knowledge in the
subjects they are teaching. The programs must have some staff available with training or education that
addresses working with limited English proficient students or students with disabilities.
a.
What is the timeline for recruitment of staff and students for the proposed program?
b.
Indicate the number of staff and staff qualifications.
c.
Describe any professional development activities planned for the staff.

Indicate funds budgeted for professional development activities $___________.
d. Is planning time for staff included? _____ Yes _____ No
If yes, how many hours per week? ________
e. How and when will staff be trained in the use of the Massachusetts Work-based Learning Plan?
Name of Grant Program: Competitive Academic Support Services
Work and Learning Programs
Fund Code: 597 (Summer)
18. Roles of Partners (if applicable)
If the program is to be implemented using a partnership between a high school or group of high schools and
an outside organization(s), describe the roles and responsibilities of the partners.
19. Program Evaluation
This funding opportunity requires applicants to submit a narrative evaluation by September 30, based on
guidelines which will be provided at the ESE website.
In order to accomplish this, please describe the process you will follow to create that narrative. Please
address who will be involved as well as how and when information will be collected and assessed.
Details and instructions will be provided by the Department to all grant recipients and will be posted to the
Academic Support Data Collection website: http://www.doe.mass.edu/as/data/.