Application Package

Request for Proposal Document

Application Package

West Virginia 21st Century Community Learning Center (21 st CCLC) Program

Thirteenth Annual Grant Competition

Anticipated funding: July, 2016 provided by

The West Virginia Department of Education http://21stcclc.k12.wv.us/ with funding from

The U.S. Department of Education http://www.ed.gov/21stcclc http://www.afterschool.gov

Minimum Funding of $50,000

Maximum Funding of $220,000

APPLICATION DUE DATE

The original application and an electronic copy on a USB flash drive must be received by 12:00 p.m., Friday, May 13, 2016, at the Office of Federal Programs, care of Brittney Bostic,

West Virginia Department of Education

Building 6, Room 330

1900 Kanawha Blvd., East

Charleston, WV 25305

[Type text]

Request for Proposal Document 2

TABLE OF CONTENTS

TABLE OF CONTENTS…………………………………………………………...2

2016 OVERVIEW…………………………………………………………………..3

GENERAL APPLICATION GUIDELINES……………………………………...4

CONTENT OF APPLICATION…………………………………………………..8

COVER PAGES…………………………………………………………………...19

APPLICATION CHECKLIST FORM…………………………………………..21

WV 21 ST CCLC PROJECT SUMMARY AND ABSTRACT FORM………….22

WVDE – 21 st CCLC GRANT BUDGET FORM………………………………...26

BUDGET NARRATIVE ITEMS…………………………………………………28

ASSURANCE FORMS……………………………………………………………30

PRINCIPLES OF EFFECTIVENESS…………………………………………...38

APPENDICES FORMS B, D, E, F……………………………………………….39

LOGIC MODEL ………………………………………………………………….46

INTENT TO APPLY FORM …………………………………………………….54


2016 OVERVIEW

West Virginia Department of Education’s

21 st Century Community Learning Center Grant Program

WHAT IS IT?

The West Virginia Department of Education (WVDE) is pleased to announce the thirteenth state

21 st Century Community Learning Center (21 st CCLC) competition for grants. The intent of this federal grant program is to provide opportunities for communities to establish activities in community learning centers that:

(1) provide opportunities for academic enrichment, including providing tutorial services to help students, particularly students who attend low-performing schools, to meet State and local student academic achievement standards in core academic subjects, such as reading and mathematics;

(2) offer students a broad array of additional services, programs, and activities, such as youth development activities, drug and violence prevention programs, counseling programs, art, music, and recreation programs, technology education programs, and character education programs, that are designed to reinforce and complement the regular academic program of participating students; and

(3) offer families of students served by community learning centers opportunities for literacy and related educational development .

This program is authorized under Title IV, Part B of the federal Elementary and Secondary

Education Act, H.R.-1. Allocations for each state are based upon a portion of a state’s Title I population ages 5-17, as well as census information. West Virginia expects to award approximately 1 million dollars in new 21 st

CCLC grants. By federal statute, a 21 st

CCLC grant may not be less than $50,000 per year. This year each eligible program may receive up to

$220,000. If you are applying for only one site, the maximum grant award is $120,000. Awarded grants cannot exceed five years with descending funds in years four and five for successful programs.


GENERAL APPLICATION GUIDELINES

WHO CAN APPLY?

Public and private organizations may apply for funding. Examples of public and private organizations include, but are not limited to: local education agencies, non-profit agencies, city and county government agencies, faith-based organizations, institutions of higher education and forprofit agencies.

Federal criteria require that states make awards to applicants that will primarily serve students that attend schools with a high concentration of low-income students.

Applicants may have a partner agency and submit a joint application from a Local Education

Agency (LEA) and at least one public or private organization, city or county governmental agency, faith-based organization, higher education institution or for-profit corporation.

The lead agency may be the LEA, the community-based organization, the faith-based organization or other public or private agency/institution, but the lead must always partner with at least one eligible school. To be eligible to apply for this grant award an applicant must serve students who primarily attend:

(i) schools eligible for schoolwide programs under Title I, Section 1114 of the

No Child Left Behind Act, and the families of these students; or

(ii) schools with at least 40 percent of its students eligible for free or reduced priced lunch, and the families of these students.

The applicant must provide evidence in Appendix F of planning with the partner agency during the creation of the application, such as meeting agendas, sign-in sheets, etc. The partner must also be described in the grant narrative as having significant, ongoing involvement in the program (as defined in the Competitive Priorities section of this application).

HOW DO WE APPLY?

Participation in this Bidders’ Conference is strongly recommended, but not required, for submission of an application. To prepare an application, use the WV 21 st

CCLC Application

Package information available for download from the WVDE 21 st

CCLC web site at http://21stcclc.k12.wv.us/ . (For general 21 st CCLC information, go to: www.ed.gov/21stcclc .)

Applicants are REQUIRED to notify WVDE of the intent to apply for 21 st

CCLC funding by

April 1, 2016.

Please email the Intent to Apply form to Benitez Jackson at bljackso@k12.wv.us

.

A list of all 2016 applicants will be sent to each applying organization.

Completed applications must arrive at the West Virginia Department of Education’s 21 st

CCLC office by 12:00 p.m. Friday, May 13, 2016. Applications will not be accepted if the current RFP has not been used, and an original signed copy along with an electronic version via USB flash drive are submitted after the 12:00 p.m. May 13 deadline.

WVDE will utilize a review process using individuals with diverse background and expertise to evaluate the applications. Grant-award announcements will be made in July, 2016 with funding also expected to begin that month. WVDE reserves the right to not award all grant monies and/or to negotiate specific grant amounts. All awards are subject to the availability of federal funds, and grants are not final until a WVDE grant award is fully executed.


To comply with ESEA Title IV Part B Section 4204 (b)(2)(L), each applicant must sign an assurance that the community was given notice of its intent to submit an application and that the application and any waiver request be available for public review after submission of the application. This form will comprise Appendix E.

Due Process for Unsuccessful Applications

Applicants that wish to appeal a grant award decision must submit a letter of appeal to the WVDE.

Appeals are limited to the grounds that the WVDE failed to correctly apply the standards for reviewing the application as specified in this RFP. Appeals based on a disagreement with the professional judgment of the grant reviewers will not be considered .

The appellant must file a full and complete written appeal, including the issue(s) in dispute, the legal authority or other basis for the appeal position, and the remedy sought. The letter must have an original signature of the authorized agent who signed the application. An original and two copies of the appeal should be delivered or mailed to:

Melanie B. Purkey

Executive Director of the Office of Federal Programs

West Virginia Department of Education

Building 6, Room 330

1900 Kanawha Boulevard East

Charleston, WV 25305-0330

The Department must receive the letter of appeal within 30 calendar days of the Notification of

Grant Award announcement. Upon review of the appeal, a response will be provided to the complainant within 30 days.

If the WVDE does not rescind its ruling, the applicant may apply to the Secretary of the U.S.

Department of Education within 20 days of the applicant receiving a written notification of the results of the appeal.

Upon request, the WVDE will make available records, pertaining to the review or appeal, including the records of other applicants.

FOR WHAT ACTIVITIES MAY A GRANTEE USE 21 ST CCLC FUNDS?

Each eligible organization that receives an award may use the funds to carry out a broad array of before- and after-school activities (including weekends and summer recess periods) that advance student achievement. In the view of the U.S. Department of Education and WVDE, local grantees are limited to providing activities within the following list:

 remedial education activities, including tutoring

 homework help

 academic enrichment learning programs, including providing additional assistance to students to allow the students to improve their academic achievement

 mathematics and science education activities

 arts and music education activities


 entrepreneurial education programs

 mentoring programs

 programs that provide after-school activities for limited English proficient students that emphasize language skills and academic achievement

 recreational activities

 telecommunications and technology education programs

 expanded library service hours

 programs that promote parental engagement, family literacy, and adult skill development

 programs that provide assistance to students who have been truant, suspended, or expelled to allow the students to improve their academic achievement

 drug and violence prevention programs, counseling programs, and character education programs

 health and nutrition

Applicants are reminded of their obligation under section 504 of the Rehabilitation Act to ensure that their proposed community learning centers program activities are accessible to persons with disabilities.

WHAT ARE THE COMPETITIVE PRIORITIES?

Priority will be given to the following:



Schools identified as a Priority or Focus School

A Priority school is one that has been identified as among the persistently lowestperforming schools in the State, irrespective of Title I eligibility, based on the most recent assessment data available. A Focus School is one that has a large gap between a particular subgroup and the non-subgroup. For high schools, the gap targeted is graduation rate. At the elementary and middle school levels the gap targeted is achievement.

Two priority points will be added to the base score for service to one listed school, 4 points for more than one listed school.



Programs that provide opportunities for participants in science, technology, engineering, arts and mathematics (STEAM) will be awarded two priority points.



Programs that provide services limited to middle school and/or high school students only will be awarded two priority points.



Services to students attending schools designated as in need of improvement under section

1116 of ESEA and that are submitted jointly by school districts receiving Title I funds and community-based organizations or other public or private organizations will be awarded four priority points. If you have received priority points under the first bullet in this section, you will only receive two additional points for the partnership.

The following clarification comes from the USDOE Nonregulatory Guidance for 21 st

CCLC programs.


In determining whether an application has been “submitted jointly,” States should look for evidence in the application that the LEA and at least one other organization collaborated in the planning and design of the program, each have substantial roles to play in the delivery of services, share grant resources to carry out those roles, and have significant ongoing involvement in the management and oversight of the program. States may want to consider what organization(s) wrote the application, what organization will be the fiscal agent, whether there is a history of these organizations working together, and whether there is evidence in the application of integration of the after-school program activities with the regular school day program. Letters of endorsement are not by themselves sufficient evidence that organizations or school districts have substantially been involved in the design of a program.

HOW IS THE APPLICATION FOR A 21 ST CCLC GRANT PREPARED?

The following information describes eligibility, required activities, application contents and application review criteria.

Applications must comply with the following format:

 the application narrative section must not exceed 25 typed and numbered pages, (not including appendices) using a 12-point,Times New Roman font; double line spacing and one-inch margins;

 chart format may be used in appropriate sections;

 the application must be on plain white paper (one side only) held together with a binder clip or stapled (no notebooks or coverings) and must not include unsolicited designs, headings, appendices, news clippings or other materials; and

 the application should respond to the exact sequence, outline form, headings and information requested herein.

 citations must be in correct American Psychological Association (APA) format.

According to the non-regulatory guidance for 21 st

CCLC, a public school or other public or private organization that is awarded a grant must provide equitable services to private school students and their families. In designing a program that meets this requirement, grantees must provide comparable opportunities for the participation of both public- and private-school students in the area served by the grant. Grantees must consult with private school officials during the design and development of the 21st CCLC program on issues such as how the children's needs will be identified and what services will be offered. Services and benefits provided to private school students must be secular, neutral, and non-ideological. This communication must be verified by completing the form that comprises Appendix D.

This form MUST be completed and signed, even if there are no private schools in your service area.

If plagiarism is found, or brought to the attention of officials at the West Virginia Department of

Education during a grant competition, then at the discretion of the Department, the WVDE has the right to remove the grant application for funding consideration.


CONTENT OF APPLICATION

To be eligible for 21 st CCLC funding, a completed 21 st CCLC application MUST contain all the following sections in the sequence provided:

1.

Cover Pages

The applicant must provide all contact and descriptive information requested on the two required cover pages. These pages must be the first two sheets of the application (see pp.18-19).

2.

Application Checklist

Include a copy of the completed checklist (see page 20).

3.

Program Summary and Abstract

Complete the required Project Summary and Abstract form describing the community needs being addressed, the participants to be served, the program objectives, the activities proposed to meet the objectives, the intended outcomes, program evaluation activities and all other requested information. (see pp. 21-24).

4.

Table of Contents

Include a table of contents with all sections and page numbers clearly identified for the application reviewers.

5.

Application Narrative

Respond to the following required application information using a maximum of 25 pages.

A.

Need for Program ( 20 points)

Describe the needs of the populations to be served by the grant program. Tell how the proposed program will help meet these needs by providing services and opportunities not currently available. It is vital that the applicant clearly show specific, identified needs that connect to the goals and measurable objectives of the application, the proposed activities and services, and the program evaluation.



Describe the needs of the community in which the students and families to be served by the grant reside. Explain why this community was selected and how the program to be provided will be of value.



Define the needs of students to be served by the grant program by subgroup, using current, specific data to document those needs. Data may include, but are not limited to, information of attendance, achievement, dropout rate, free/reduced lunch rate and risky behaviors.



Define the data-based needs of the community to be served by the grant program, focusing on parents and families. Data may include, but are not limited to, poverty rates, literacy rates and education levels.



Describe the gaps in community services and opportunities for those living in the area included in the proposed program area. Tell how the grant will help provide services and activities not available at this time for participants in the program.



Cite any research information shared in this section using APA citation of the data source.




Tell how the applicant consulted with private school officials during the design and development of the application as to the needs to be addressed and the services to be offered. If there is no private school within the applicant’s attendance area, this needs to be stated by the applicant.



Include data from a community needs assessment conducted within the last three years to support identified needs.



Reapplying organizations must provide no more than a one-page summary of data

/evidence in Appendix B of having met the objectives of their last 21 st CCLC grant.

B.

Goals and Objectives ( 15 points)



Develop broad program goals that address identified needs from section A. One goal must address raising academic achievement for students with a second goal addressing raising the education or skill levels of adults.

Other goals may be added if needed. Goals are statements of what you are working to achieve. They do not have to be measurable.

(Please consider school and district goals when developing goals for your program.)



List the measurable objective(s) the proposed program will use to remedy the risk factors

(needs) described for the target populations in the goals identified. Effective measurable objectives are considered SMART objectives, with that acronym standing for Specific,

Measurable, Attainable, Realistic and Time-bound. (Be sure to consider how you will evaluate the objectives. That information must be included in the evaluation section of the application.)



Be sure that grant goals and objectives have been created to sufficiently meet the critical data-based needs of the students, parents and families in the community.



Those applicants who have previously received 21 st CCLC funding, MUST provide no more than a one-page summary of data/evidence in Appendix B documenting the improvement of student achievement.



Those applicants who have previously received 21 st CCLC funding, MUST provide no more than a one-page summary of data/evidence in Appendix B documenting the utilization of partner organizations to enhance academic performance, achievement and positive youth development of students.

These are Federal Targets to be considered when developing program objectives.

Federal Target*

Forty-eight percent of students participating in this program will improve their reading and language arts grades.

Forty-eight percent of students participating in this program will improve their mathematics grades.

Seventy-five percent of students participating in this program will demonstrate improvement in homework completion and class participation.

Seventy-five percent of students participating in this program will demonstrate improvement in behavior.

Eighty-five percent of out-of-school time centers emphasize programming in at least one core academic subject area.

Eighty-five percent of out-of-school time centers offer academic enrichment and support activities related to technology.

Eighty-five percent of out-of-school time centers offer academic enrichment, support activities, and programming to support student learning outside of core subject areas and technology.

Federal Targets are subject to change based on federal guidelines.


C.

Student Program Activities & Implementation ( 20 points)



Describe the components and related activities that your program will offer to students to meet the needs previously identified. Include information on time allotted to program components and activities, as well as partner involvement.



Identify scientifically-based research that provides evidence that the programs or activities you include in this section will help students meet state and local student academic achievement standards.



Describe plans for implementing optional summer programs, if desired. Programs will not receive credit for having a summer program if sufficient funds are not included in the budgets for years 1-3 and in the budget narrative.



Explain how students will be recruited and retained in the program.



Describe how program services in centers will be available to any participating student a minimum of three days for high school programs and four days per week for elementary and middle school students. All programs must begin by October 15 and meet a minimum of 25 weeks during the regular school year.

A mandatory pre-site meeting with WVDE Staff, co-applicant partner (if applicable) program director, site coordinator, community partners, principal, and central office administrator representing the schools of participating students must be held with first-time subgrantees prior to the start of the program.



Explain how project staff will vary their approaches to help meet the individual needs of students and improve their achievement in core academic areas to meet or exceed local and state standards.

Include the steps you propose to ensure equitable access to, and participation by, students and program personnel with special needs.



Describe how the proposed program will provide hands-on, problem-based or project-based learning activities that support state and local learning standards and contribute to academic performance for all students.



Include plans to provide supper for participating students each day the program meets. A snack may also be offered.

D. Collaboration (15 points)



Explain how the program was developed and will be carried out in active collaboration with the schools the students attend. Include how joint planning time and professional development opportunities will be available for school staff, program staff and partners that will help meet both program goals and objectives, as well as school and district goals and objectives. Those applicants who have previously received 21 st CCLC funding must describe in no more than one page in Appendix B, the collaboration between their previously-funded program and the schools that students attended .



Explain the data-sharing plan for your program: how you will access student records and individual and aggregate achievement data for use in program planning, implementation and evaluation; as well as how you will share program data with the schools served.

Include the process you will use to gain individual parent consent to access and use an individual student’s data.



Describe the partnership details between a local educational agency and community-based, faith-based, or other public or private organization(s) submitting MOUs that focus on

Request for Proposal Document 11 aspects of the program beyond activities offered (for example, training, supplies, funding, etc.)



Describe the prior experience and/or capacity of the lead organization and co-applicant partner, if applicable, to provide educational and related activities that will complement and enhance the academic performance, achievement, and positive youth development of students.



Attach Memoranda of Understanding or letters that clearly indicate the role, capacity, specific contributions and in-kind value of each partnering organization. A letter from the principal of each participating school must be included.



If you have identified a partner agency on the cover sheet, be sure to address the definition of “submitted jointly” found in the competitive priorities section of the application.

E. Facility Plan (10 points)



Describe how the program provides a safe, welcoming environment for participants.

Include specific information that describes the interior and exterior environment of the site.



List the required agency inspections that are conducted at non-school based sites(s), including the State Fire Marshall Report and a county-level Health Department inspection.

During the pre-site visit of each new subgrantee, an environmental rating will be done to assess program facilities and inspection reports. This checklist is posted on the applications resources page of the 21 st CCLC WVDE web site. http://wvde.state.wv.us/21stcclc/resources.html



Tell how the program will ensure that the students will travel safely to and from the 21 st

CCLC and home from school–based and/or off- site programs. State the number of buses needed to adequately serve the target participants, based on data provided by the county board of education and/or principal.



Tell how the emergency exit plan and emergency readiness plan will be communicated to the staff, students and parents, and how fire drills will be conducted during afterschool hours.

F. Program Personnel (15 points)

Describe procedures for managing the program.



Use a chart to describe the staff structure (roles and responsibilities). Include position descriptions for key community and school staff. Due to hiring requirements and personnel procedures, it is not necessary to name in the application a specific person to serve as the program director. However, position descriptions for the personnel you intend to employ with 21 st

CCLC funding should be included.



Staffing is to be at a level that assures participant safety, as well as the highest quality of program delivery based on the type of activity, programmatic level and number of participants. Suggested guidelines, such as those from West Virginia Department of Health and Human Resources, state:

A center shall group children and consider their ages when determining the staff: child ratio as follows:



9.2.a. For programs that operate with Pre-K children, the program shall ensure that:



9.2.a.1. A 1:12 staff to child ratio is maintained; and


 9.2.a.2. Group sizes are limited to 24 for any group that mixes older children with a pre-k child.



9.2.b. For programs that operate with school age children only, the program shall ensure that:



9.2.b.1. A 1:16 staff to child ratio is maintained;



9.2.b.2. The group size is determined by the activity and is limited to facilitate staff/child interaction and safe, constructive participation by children; and



9.2.c. During water activity such as swimming, canoeing, and fishing the staff: child ratio is maintained at 1:8 for groups of school age children and is maintained at 1:4 for any group with a Pre-k child.



9.3. Groups of children must be distinct with staff persons knowing to which group they are assigned.



9.4. Staff: child ratio and group size are always maintained based on the age of the

youngest child in the group.



Describe plans and budget for on-going staff training for the program. Expenses may include payment of staff for time to plan and attend the training. The budget must include funding for the following required professional development opportunities at a minimum:

1.

The program director to attend the Multi-State Fall Conference annually

(Include $150 for registration cost per person, plus travel, food and lodging.)

2.

The program director and one program staff member who is responsible for planning and implementing daily programming to attend one WVDE-sponsored 21st CCLC conference annually (Include $150 for registration cost per person, plus travel, food and lodging.)

3.

New directors to attend four partial-day, drive-in meetings throughout the year (travel only)

Inclusion of other state, regional and national training is optional. The USDE 21 st

CCLC office may conduct a regional conference. Other organizations conduct national conferences annually.



Describe how qualified volunteers will be used to support proposed activities.



Require the Program Director to allocate a minimum of 10 hours per week to carry out grant responsibilities. Time and effort sheets will be submitted as verification.

It may also be useful to designate a staff member as a school liaison to make necessary connections between the regular school day and the afterschool program to create a

“learning day”.



Require at least one full-time staff member per site to be certified in both CPR and first aid

(within one month of employment).



Ensure that all out-of-school-time staff and regular volunteers have passed an approved state-level background check prior to working in the program to assure that the program does not hire employees that may pose a danger to children. Include funds in the budget and budget narrative for this expense. Suggested guidelines, such as those from West

Virginia Department of Health and Human Resources, state:


Convictions 5.1 The applicant shall not be approved, employed, utilized nor considered for a waiver if ever convicted of:



5.1.1 Abduction;



5.1.2 Any violent felony crime including but not limited to rape, sexual assault, homicide, malicious wounding, unlawful wounding, felonious domestic assault or battery;



5.1.3 Child/adult abuse or neglect;



5.1.4 Crimes which involve the exploitation of a child or an incapacitated adult;



5.1.5 Misdemeanor domestic battery or domestic assault;



5.1.6 Felony arson;



5.1.7 Felony or misdemeanor crime against a child or incapacitated adult which causes harm;



5.1.8 Felony drug related offenses within the last ten (10) years;



5.1.9 Felony DUI within the last ten (10) years;



5.1.10 Hate crimes;



5.1.11 Kidnapping;



5.1.12 Murder/homicide;



5.1.13 Neglect or abuse by a caregiver;



5.1.14 Pornography crimes involving children or incapacitated adults including but not limited to, use of minors in filming sexually explicit conduct, distribution and exhibition of material depicting minors in sexually explicit conduct or sending, distributing, exhibiting, possessing, displaying or transporting material by a parent, guardian or custodian, depicting a child engaged in sexually explicit conduct;



5.1.15 Purchase or sale of a child; CIB Background Checks Revised March 15, 2015 9



5.1.16 Sexual offenses including but not limited to incest, sexual abuse, or indecent exposure.



Further information can be found here: http://www.dhhr.wv.gov/bcf/Providers/Documents/CIB%20Policy.pdf



Describe a program Advisory Council that will meet at least quarterly and consist of program staff, co-applicant partner and school/district administrative staff, parents, students and community members.

G. Sustainability (15 points)

Since grant funding is intended as an incentive to promote the long-range establishment of out-of-school-time community programs, the application must include the following:



Describe how the budget is reasonable in relation to the number of average daily attendees to be served, services to be provided and anticipated results and benefits. The budget and budget narrative will be judged against the scope of the program and its anticipated benefits.



Describe how other sources of funding will be leveraged to supplement the grant award and to support services, including coordination with other federal, state and local programs with compatible/complementary services (i.e. Title I, Adult Basic Education etc.)



Explain how the program will ensure that funds will not be used to supplant federal, state, local or non-federal funds.



Applicants who choose to establish a fee structure must provide a narrative that explains the fee structure and how they will assure that income and or ability to pay will not deter families from enrolling their children in the program. Additionally, they must describe how the funds will be administered and managed. Anticipated income from collection of fees must be reported in the budget as an additional source of revenue.




Provide a reasonable plan for sustaining the community learning center(s) after grant funding ends.

Beginning with the 2012 subgrantee cohort, if reapplication is made for the same sites included in this grant in five years (or if 50% or more of the sites remain the same), the maximum funding would be figured at 70% of the year one of the previous grant award.

However, at no time may a grant be awarded for less than $50,000.

H. Parent, Family and Community Involvement (15 points)



Describe the components and related activities that your program will offer to parents, families and community members to meet the needs previously identified in section A.

These activities MUST be aimed at improving the education or skill level of adults or at involving parents in their children’s learning, either at home, at programs sponsored by the center, or elsewhere.



Include the steps you propose to ensure equitable access to, and participation by family members and other program beneficiaries with special needs.



Describe how students, parents and community members will be involved in planning, implementation of services, program evaluation and decision-making in the program.



Explain how your program will disseminate information about the center(s) to the community in a manner that is understandable and accessible.

6. Program Monitoring and Evaluation (20 points)

It is important that each applicant engage in internal monitoring that will help track continuous progress toward meeting grant goals and objectives. This shall be accomplished via a two-step process. First, grantees will develop a Program Logic Model that provides a roadmap for the proposed program. This model must include measureable objectives that align to CCLC program goals, activities, inputs, outputs, outcomes and data-based indicators. Good logic models will include both process and outcome measures. Process measures should include the documentation of significant project milestones/completion of key tasks (e.g., number of participants, number of events sponsored, etc.). Outcome measures should reflect the intended results of your project (e.g., indicators of progress in impacting student learning).

Second, all applicants must provide a narrative that indicates how continuous self-monitoring will be employed to improve and strengthen their program. This narrative should describe the steps that grantees will take to collect evidence of completing program activities, objectives, and outcomes, the process for reviewing this information, and how such information will drive changes in program decision-making. The internal monitoring plan should also include a time line of monitoring activities that clearly aligns to the information provided in the Program Logic Model.

Detailed requirements for the Program Logic Model and Internal Monitoring Plan are described below. These need to be put into the application at the end of the narrative section. They will not be counted in the 25 page maximum.

Program Logic Model and Internal Monitoring Plan

The purpose of the project logic model and internal monitoring plan component of the 21 st

Century

Community Learning Centers program is to help guide applicants’ in the planning of their projects and to ensure grantees are continuously using data to assess progress toward meeting project goals and to engage in continuous improvement. All applications must include the following components:


1.

Program Logic Model:



A logic model is a tool used to depict the logical relationships that exist among program goals, objectives, activities, inputs, and outputs/outcomes. It also describes the data-based indicators that will be used to provide evidence of the program’s effectiveness. All applicants must submit a completed program logic model using the template provided on p. 45 (use the template for each program goal; make additional copies as needed).

It is strongly recommended that grantees complete the logic model prior to writing the application narrative as it can greatly assist with preparing a quality application. Please note, applicants must use the definitions below when completing the program logic model.

Goal - a broad statement of intended outcomes for the program

Objective – a detailed statement of intended outcomes that includes the population, outcome, target, measure, and time frame (all Objectives must be Specific, Measurable,

Attainable, Realistic, and Time-bound. See SMART objective guiding questions on the application resource page of the WV 21 st

CCLC website, http://wvde.state.wv.us/21stcclc/resources.html

).

Activities – actions needed to meet objectives

Inputs - resources needed to design and implement activities

Outputs - tangible services and products that are direct results of activities

Outcomes – specific, attainable, measurable changes that are likely to occur as a result of the activities

Indicators – data to monitor implementation and measure progress, as well as success of the initiative



An example of a high quality logic model submitted by a previous CCLC grantee is provided on p. 47.

2.

Internal Monitoring Plan:



The internal monitoring plan is a narrative that describes the methods that will be used throughout the program to monitor accomplishment of the objectives included in the logic model. This narrative must include a description of: (a) the applicant’s capacity to access, collect, and analyze the data necessary to effectively document program objectives and outcomes; (b) the specific action steps that will be taken to monitor the activities included in the logic model, including a time line for completion of these activities; (c) assurances that monitoring results will be documented quarterly; and (d) how monitoring results will be continuously reviewed and used to inform program decision-making. All applicants must submit a completed internal monitoring plan narrative addressing all program goals. This will not count toward the 25 page maximum.

The quality of the program logic model and internal monitoring plan narrative will be considered major factors when selecting grantees.

During the course of the program’s implementation the logic model and monitoring plan may be amended upon WVDE 21 st

CCLC administrative approval.


State and Federal Evaluation Requirements

All applicants must provide an assurance that they will participate meaningfully in mandated annual evaluation activities consisting of the following:



Collection of a completed Annual Performance Report (APR) data through a

WVDE data system



Completion of Grantee Profile information in USDOE 21 APR SYSTEM



Completion of the annual Teacher Survey by the regular classroom reading/language arts or mathematics teacher of regular attendees of the program.



Submission of the completed annual Program Director Survey

Applicants must also provide an assurance that they will participate in program monitoring conducted by WVDE 21 st

CCLC staff consisting of the following:



Submission of required documentation, and



Arrangement of focus group interviews with key stakeholders.

Please Note:

Awarded subgrantees will be held to the following standards, unless a waiver has been approved by the state office based on extenuating circumstances. Programs must be successful in at least three of the identified areas or they are considered a “high-risk” subgrantee.



Attendance – Based on 21 st

CCLC student registration, sites will have at least 70% of enrolled students attending a minimum of 20 days and at least 50% attending a minimum of 30 days.



Goal/objective attainment

—Programs will have met, or made significant progress toward, goal attainment. In year one, when programs are being established, progress will be made toward meeting objectives as stated in the grant application; in year two and three at least 50 percent of stated goals/objectives will be met; and by years four and five all goals and objectives will be met.



Grant program implementation

—Subgrantees will implement the program as described in the approved application.



Adequate, qualified staffing

—Staffing is to be at a level that assures participant safety, as well as the highest quality of program delivery based on the type of activity, programmatic level and number of participants. (suggested guidelines in

Program Personnel section)



Program management

—Staff is organized by clearly defined roles and responsibilities that are adequate to carry out the program successfully. Staff members and individuals or entities providing goods or services are selected based on prior experience, qualifications and, where applicable, specialized training and/or certification. Staff has received training in regard to their responsibilities and

Request for Proposal Document 17 understand their role in the overall program

7.

Budget and Budget Narrative (10 points)



Complete a WVDE Budget Form (see pp. 25-26) for each of the first three years of the project.



Provide a detailed budget narrative for the first year only using the form provided on page

27 that clearly explains:

the mathematical basis for estimating the costs of professional personnel salaries, fringe benefits, project staff travel, student transportation, materials and supplies, consultant and subcontract fees, indirect costs and other program expenditures; ( Be sure to name each staff position and provide the formula for rate of pay and the duration of services.)

detailed description explaining in-kind support and/or funding/resources provided by co-applicant partners (if applicable) and other collaborating partners in the program.

(Funded programs reporting successful implementation will be asked to provide continuation applications and budgets for each of the five years of the program if federal funding continues. Year four funding will be, at maximum, 80% of the year one amount.

Year five will be, at maximum, 70% of the year one amount.)

 indirect costs must align with the applying organization’s approved restricted indirect cost rate.

Please keep in mind that there is a policy relating to average daily attendance and funding. In grant years three through five, if the program average daily attendance is less than 80% of the average daily attendance number set forth in the original budget, the grantee's budget will be proportionately reduced by the amount of the percentage deficiency from the original budget.

Examples: Based on a total program average daily attendance of 50, 80% would be 40 students. If a program said it would serve an Average Daily Attendance of 50, but only had an ADA of 35 students, based on a single-site grant of $120,000, that would be a cut of $12,000. If a program said it would have an ADA of 90, 80% would be 72 students. If they only had 60 students, based on a grant of $220,000, it would be cut $28,600.

Note: grant funds cannot be used to purchase food, facilities or vehicles, or to support construction.

Federal regulations that apply to the 21 st CCLC program are: the U.S Education Department

General Administrative Regulations (EDGAR) in 34 CFR Parts 75, 77, 79, 80, 81, 82, 85, and 86, and (b) 34 CFR Part 299. The EDGAR regulations can be found on the Department’s website: http://www.ed.gov/about/offices/list/index.html?src+mr . Office of Management and Budget

Circulars A-21 for educational institutions and A-122 for non-profit programs also provide guidance on cost principles.

8.

Assurances Forms (see pp. 29-36)

Attach the properly signed and completed assurances forms.

9.

Appendices (see pp. 38-44)


Attach only the following Appendices:



Appendix A: a REQUIRED list of collaborating partners with contact names, addresses, year-round telephone numbers, fax numbers and e-mail addresses; and a memorandum of understanding or partner letter that clearly documents the role and contribution of the partner, as well as the in-kind value if applicable (not a generic letter of support)



Appendix B: documentation of previous grant success, as noted in the applicable sections of grant directions ( REQUIRED of previous applicants)



Appendix C: a summary of any evaluation studies, reports, or research that documents the effectiveness or success of the co-applicant partner (if applicable) and collaborating partners and of the activities and services proposed in the narrative section of the application (OPTIONAL )



Appendix D : REQUIRED form to verify consultation with private school personnel



Appendix E: REQUIRED form to verify sharing with the community



Appendix F: evidence of planning application with grant co-applicant partner

( REQUIRED if submitting jointly)


COVER PAGES

WVDE 21 st Century Community Learning Centers Grant Application

School Years 2016-2021

Local Project Title:

Lead Agency

Contact Person:

Phone #:

Address:

Fax #: Email:

Fiscal Agency

Contact Person:

Phone # Fax #:

Address:

Email:

Co-Applicant Partner Agency*:

Contact Person:

Phone #: Fax #: Email:

Address:

*Optional-This is a competitive priority as defined in application section, “What are the Competitive Priorities?”

Other Collaborating Partnerships

Number of collaborating partners actively involved in the project

Schools Community-Based Organizations ___Faith-Based Organizations

___Community/business ___Other (list)

School District(s) ________________________________________________________


Schools Served

Number of sites ________________

Funds Requested

Estimated number of students to be served:______ Proposed cost per student:________

FEIN Number (Federal Employees Identification Number)

West Virginia Vendor Number

Proposed Program Dates July, 2016 6-30-19 start date end date

Matching (local) funds: $ _________________

In-kind $ Cash $ Other (list)

Have you previously received 21 st Century Community Learning Center funding from the

West Virginia Department of Education? Yes____ No _____

Date: ____________________

Agency Head’s/Superintendent’s Signature*

*Signature indicates that applicant agrees to all conditions in the proposal.


APPLICATION CHECKLIST FORM

One original copy of the application along, with an electronic copy on a USB flash drive must be received by 12:00 p.m., Friday, May 13, 2016, at the office of Brittney Bostic, Office of

Federal Programs, West Virginia Department of Education, Building 6, Room 330, 1900

Kanawha Boulevard East, Charleston, WV 25305.

Five points will be deducted from the score of the application if the sections below are not addressed in the order listed. (Check each of the following items as they are completed.)

1.) Cover Pages, fully completed and signed by an authorized official.

2.) Application Checklist, completed

3.) Program Summary and Abstract

4.) Table of Contents

5.) Program Narrative

6.) Logic Model and Internal Monitoring Plan

7.) Budget and Budget Narrative

8.) The required Assurances, Certifications, and Disclosure forms (must be signed by an authorized official).



Non-Construction Programs (Form OMB 424B)



The certification regarding lobbying; debarment, suspension and other responsibility

matters and



Drug-free workplace requirements (Form ED-80-0013)

9.) The Appendices

10.) Bibliography (APA Format)

11.) Electronic copy on a USB flash drive has been submitted along with the original copy of the application


WV 21 ST CCLC PROJECT SUMMARY AND ABSTRACT FORM

Student Populations to be Served (indicate number of schools in blank)

___ Elementary Schools ___ Middle Schools ___ High Schools

___ Priority Schools ___ Focus Schools

___ Title I schools

Co-applicant Partner(s) and Collaborating Organizations (indicate number in blank)

___ National Organizations (e.g., Boys & Girl Clubs,

YMCA/YWCA, Big Brothers/Big Sisters) police, Parks & Recreation, Social

___ Community-Based Organizations profits or foundations)

(local non- Services)

___ Colleges or Universities

___ Libraries or Museums

___ Businesses

___ Faith-Based Organizations

___ Hospitals/Clinics/Health Providers

___ other __________________________

Services to be Provided (check all that apply)

 Reading or Literacy

 Mathematics

 Science

 Art, Music, Dance,

Theater

 Physical Education

 Technology, Video or Media

 Service Learning

 Cultural Activities, Social

Studies

 Health, Nutrition

 Youth Development

 Services for Adults

 Homework Help

 Tutoring

 Other ___________

Times of Operation

Before school After school Summer Weekend


Page 2 -- Program Summary and Abstract

Name & location of each site

Days and times of program operation throughout week

Estimated number of students to be served annually

Estimated average daily attendance

Estimated total number or attendees

30 days or more

Student

Free/

Reduced

Lunch %

Estimated adults/ family members served

Totals for the entire program

Mon Tues Wed Thur Fri Sat




Mon Tue Wed Thur Fri Sat

Total estimate of students to be served

______

Total estimate of attendees 30 days or more

________

Average

% of

Free

Reduced

Lunch students

________

Total estimate of adults/ family members served

________

*Start date of each site is no later than October 15th.

Estimated number to be served does not refer to the total school population but to the estimated students likely to participate. Explain how that number of student and adult and/or family participants was determined:

_________________________________________________________________________________________________

_________________________________________________________________________________________________


Abstract. In the space below, briefly describe your program’s goals, services, activities, and planned participants.

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________


Program Summary and Abstract for Summer (if applicable)

Name & location of each site

Totals for the entire program

Days and times of program operation throughout week





Mon Tue Wed Thur Fri Sat

Estimated number of students to be served annually

Total estimate of students to be served

______

Estimated average daily attendance

Estimated adults/ family members served

Total estimate of adults/ family members served

________


WVDE – 21 st CCLC GRANT BUDGET FORM

County Agency/School _____________

Financial Contact Person _______________________________________________

Complete Street Address _______________________________________________

Phone # Fax # E-mail __________________________

Federal Funding (Line Items)

Administrative Salary

Salary- Program Director

Salary- Secretary

Salary- Financial Officer

Salary-Assistant

Fringe Benefits-rate: _____

Programmatic Salary

Salary- Site Coordinators

Subtotal

Funds Requested

$ _______

$ _______

$ _______

$ _______

$ _______

$ _______

Salary- Site Staff (

Tutor, Homework Help, Enrichment, Physical Activities

Salary- Support Personnel (

Fringe Benefits-rate: _____

Cooks, Custodians, Bus Drivers, Aides

Salary-Other ___________________

)

)

Subtotal

Other Expenses

$ _______

$ _______

$ _______

$ _______

$ _______

$ _______

Supplies/Consumables

Equipment

Student Transportation

Administrative and Staff Travel

Training

$ _______

$ _______

$ _______

Facility Rental

Background checks

$ _______

$ _______

$ _______

$ _______

Other (describe) __________________________________________ $ _______

Subtotal $ _______

Total Direct Costs $ _______

Indirect cost-approved rate: ______ $ _______

TOTAL FEDERAL FUNDING REQUESTED $ _______

Revised 2-27-14

Last Updated: April 16, 2020


Local Funding & Contributions (Line Items)

Administrative

Matching Funds

Salary- Program Director

Salary- Secretary

Salary- Financial Officer

Salary-Assistant

Fringe Benefits

$ _______

$ _______

$ _______

$ _______

$ _______

$ _______

Programmatic

Salary- Site Coordinators

Subtotal

Salary- Site Staff (

Tutor, Homework Help, Enrichment, Physical Activities

)

Salary- Support Personnel (

Cooks, Custodians, Bus Drivers, Aides

)

Salary-Other ___________________

Fringe Benefits

Subtotal

Other Expenses

Supplies/consumables

Equipment

Student Transportation

Administrative and Staff Travel

Training

$ _______

$ _______

$ _______

$ _______

$ _______

$ _______

$ _______

$ _______

$ _______

$ _______

$ _______

Program Evaluation

Facility Rental

$ _______

$ _______

Background checks $ _______

Other (describe) __________________________________________ $ _______

Subtotal $ _______

LOCAL FUNDING CONTRIBUTIONS TOTAL $ _______

TOTAL PROGRAM BUDGET (FEDERAL + LOCAL) $ _______

_________________________________________________________ Date _______

Superintendent’s or Agency Director’s Signature

**************************************************************************************

STATE USE ONLY

Federal Funds Approved $ Program Code _______________

Account # 8712-13000 Revenue Code 04511 FIMS ID _________

Date_______________

State Agency’s Signature

Revised 2-27-14



BUDGET NARRATIVE ITEMS

Your proposal must have a budget narrative explaining each line item on your

2016-2017 Budget Form. List each of your requested budget items in the same order they appear on the 2016-2017 Budget Form, whether it is federally funded or a local contribution, the purpose, and the math used to estimate it. Double-click on the table cell to enter data or to add additional rows if needed. The total cost column will automatically calculate vertically to give you the total expenditures for the application.

Budget Item Funding Souce Funding Purpose &Calculations Total Cost

Total grant costs

Note: It is your responsibility to maintain documentation for 5 years to support expenditures.

0



EXAMPLE OF BUDGET NARRATIVE ITEMS

Budget Item

Salary

Funding Examples of Funding Purposes & Calculations

1 Project Director x $2,500/month x 12 months = $30,000 +

Federal fringe benefits (Social Security 7.65%, Workers Comp

1.32%) $2,691

Federal 2 VISTA workers x $10,000/year

Federal 1 Karate teacher x $20/hour x 2 hours/week x 8 weeks

Local 1 Dentist x $300/day x12 days

Total Cost

32,691

20,000

320

3,600

Supplies

Local

Federal

Local

1 Part-time secretary x $15/hour X 10 hours x 25 weeks

Federal 10 Basketballs x $10.00/ball

Federal 10 Modeling clay x 20.00/box

10 Magnifying glasses x $8/per

25 Watercolor paint x $2/set

1 Bus driver x$20/hour x 3 hours/day x 4 days/week x 25 weeks = $6,000 + fringe (Social Security 7.65%, Workers

Comp 1.32%) Transportation Federal

Travel

Local

1 Bus driver (field trips) x $20/hour x 12 hours =$240 + fringe (Social Security 7.65%, Workers Comp 1.32%)

Federal

2 staff members X 2 WVDE training registration fees x

$250/training

Federal 2 staff members X 100 miles x $.50/mile

3,750

100

200

80

50

6,538

262

1000

100



ASSURANCE FORMS

Lobbying, Debarment, Suspension, etc. form ED 80-0013

CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND

OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE

REQUIREMENTS

Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the instructions for certification included in the regulations before completing this form. Signature of this form provides for compliance with certification requirements under 34 CFR Part 82, "New Restrictions on Lobbying," and 34 CFR

Part 85, "Government-wide Debarment and Suspension (Nonprocurement) and Governmentwide Requirements for Drug-Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of

Education determines to award the covered transaction, grant, or cooperative agreement.

1.

LOBBYING

As required by Section 1352, Title 31 of the U.S. Code, and implemented at 34 CFR Part 82, for persons entering into a grant or cooperative agreement over $100,000, as defined at 34 CFR Part

82, Sections 82.105 and 82.110, the applicant certifies that:

(a) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a

Member of Congress in connection with the making of any federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal grant or cooperative agreement;

(b) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a

Member of Congress, an officer or employee of Congress, or an employee of a Member of

Congress in connection with this federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions;

(c) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all subrecipients shall certify and disclose accordingly.

2.

DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS

As required by Executive Order 12549, Debarment and Suspension, and implemented at 34 CFR

Part 85, for prospective participants in primary covered transactions, as defined at 34 CFR Part

85, Sections 85.105 and 85.110--

A. The applicant certifies that it and its principals:

(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;



(b) Have not within a three-year period preceding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph

(2)(b) of this certification; and

(d) Have not within a three-year period preceding this application had one or more public transaction (federal, state, or local) terminated for cause or default; and

B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application.

3.

DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS)

As required by the Drug-Free Workplace Act of 1988, and implemented at 34 CFR Part 85,

Subpart F, for grantees, as defined at 34 CFR Part 85, Sections 85.605 and 85.610 -

A.

The applicant certifies that it will or will continue to provide a drug-free workplace by:

(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition;

(b) Establishing an on-going drug-free awareness program to inform employees about:

(1) The dangers of drug abuse in the workplace;

(2) The grantee's policy of maintaining a drug-free workplace;

(3) Any available drug counseling, rehabilitation, and employee assistance programs; and

(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;

(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a);

(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will:

(1) Abide by the terms of the statement; and

(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction;

(e) Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction.

Employers of convicted employees must provide notice, including position title, to: Director,

Grants Policy and Oversight Staff, U.S. Department of Education, 400 Maryland Avenue, S.W.

(Room 3652, GSA Regional Office Building No. 3), Washington, DC 20202-4248. Notice shall include the identification number(s) of each affected grant;



(f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted:

(1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or

(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;

(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e), and (f).

B.

The grantee may insert below the site(s) for the performance of work done in connection with the specific grant: Place of Performance (street address. city, county, state, zip code)

Check if there are workplaces on file that are not identified here.

DRUG-FREE WORKPLACE (GRANTEES WHO ARE INDIVIDUALS)

As required by the Drug-Free Workplace Act of 1988, and implemented at 34 CFR Part 85,

Subpart F, for grantees, as defined at 34 CFR Part 85, Sections 85.605 and 85.610-

A.

As a condition of the grant, I certify that I will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant; and

B.

If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, I will report the conviction, in writing, within 10 calendar days of the conviction, to: Director, Grants Policy and Oversight Staff, Department of Education,

400 Maryland Avenue, S.W. (Room 3652, GSA Regional Office Building No. 3),

Washington, DC 20202-4248. Notice shall include the identification number(s) of each affected grant.

As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications.

NAME OF APPLICANT:

PROJECT NAME:

PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE:

SIGNATURE: DATE:

ED 80-0013 10/08



ASSURANCES - 2

Non-Construction form SF 424B

OMB Approval No. 0348-0040

ASSURANCES - NON-CONSTRUCTION PROGRAMS

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget,

Paperwork Reduction Project (0348-0040), Washington, DC 20503

Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.

As the duly authorized representative of the applicant I certify that the applicant:

1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and completion of the project described in this application.

2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the state, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.

3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain.

4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.

5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 004728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of

Personnel Administration (5 C.F.R. 900, Subpart F).

6. Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education

-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as

-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L.

92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the



Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse

290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient reco amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s) which may apply to the application.

7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform

Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of federal participation in purchases.

8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. 001501-1508 and

7324-7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with federal funds.

9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. 00276a to

276a-

-333), regarding labor standards for federally assisted construction subagreements.

10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.

11. Will comply with environmental standards which may be prescribed pursuant to the following:

(a) institution of environmental quality control measures under the National Environmental

Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved state management program developed under the Coastal to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S

water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended,

(P.L. 93-205).

12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 001721 et seq.) related to protecting components or potential components of the national wild and scenic rivers system.

13. Will assist the awarding agency in assuring compliance with Section 106 of the National and protection of historic properties), and the Archaeological and Historic Preservation Act of

-1 et seq.).



14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance.

15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 animals held for research, teaching, or other activities supported by this award of assistance.

16. Will comply with the Lead-Based Paint Poisoning Prevention A which prohibits the use of lead-based paint in construction or rehabilitation of residence structures.

17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-

Local Governments, and Non-

18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies governing this program.

NAME OF APPLICANT:

PROJECT NAME:

SIGNATURE:

DATE:

Standard Form 424B (Rev. 7-97) Back



ASSURANCES - 3

GEPA Equitable Access form 1890-0007

OMB Control No. 1890-0007 (Exp. 09/30/2004)

NOTICE TO ALL APPLICANTS

The purpose of this enclosure is to inform you about a new provision in the Department of

Education's General Education Provisions Act (GEPA) that applies to applicants for new grant awards under Department programs. This provision is Section 427 of GEPA, enacted as part of the Improving America's Schools Act of 1994 (Public Law (P.L.) 103-382).

To Whom Does This Provision Apply?

Section 427 of GEPA affects applicants for new grant awards under this program. ALL

APPLICANTS FOR NEW AWARDS MUST INCLUDE INFORMATION IN THEIR

APPLICATIONS TO ADDRESS THIS NEW PROVISION IN ORDER TO RECEIVE

FUNDING UNDER THIS PROGRAM.

(If this program is a state-formula grant program, a state needs to provide this description only for projects or activities that it carries out with funds reserved for state-level uses. In addition, local school districts or other eligible applicants that apply to the state for funding need to provide this description in their applications to the state for funding. The state would be responsible for ensuring that the school district or other local entity has submitted a sufficient section 427 statement as described below.)

What Does This Provision Require?

Section 427 requires each applicant for funds (other than an individual person) to include in its application a description of the steps the applicant proposes to take to ensure equitable access to, and participation in, its federally-assisted program for students, teachers, and other program beneficiaries with special needs.

This provision allows applicants discretion in developing the required description. The statute highlights six types of barriers that can impede equitable access or participation: gender, race, national origin, color, disability, or age. Based on local circumstances, you should determine whether these or other barriers may prevent your students, teachers, etc. from such access or participation in, the federally-funded project or activity. The description in your application of steps to be taken to overcome these barriers need not be lengthy; you may provide a clear and succinct description of how you plan to address those barriers that are applicable to your circumstances. In addition, the information may be provided in a single narrative, or, if appropriate, may be discussed in connection with related topics in the application.

Section 427 is not intended to duplicate the requirements of civil rights statutes, but rather to ensure that, in designing their projects, applicants for federal funds address equity concerns that may affect the ability of certain potential beneficiaries to fully participate in the project and to achieve to high standards. Consistent with program requirements and its approved application, an applicant may use the federal funds awarded to it to eliminate barriers it identifies.

What are Examples of How an Applicant Might Satisfy the Requirement of This

Provision?

The following examples may help illustrate how an applicant may comply with Section 427.



(1) An applicant that proposes to carry out an adult literacy project serving, among others, adults with limited English proficiency, might describe in its application how it intends to distribute a brochure about the proposed project to such potential participants in their native language.

(2) An applicant that proposes to develop instructional materials for classroom use might describe how it will make the materials available on audio tape or in Braille for students who are blind.

(3) An applicant that proposes to carry out a model science program for secondary students and is concerned that girls may be less likely than boys to enroll in the course, might indicate how it intends to conduct "outreach" efforts to girls, to encourage their enrollment.

We recognize that many applicants may already be implementing effective steps to ensure equity of access and participation in their grant programs, and we appreciate your cooperation in responding to the requirements of this provision.

Estimated Burden Statement for GEPA Requirements

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid

OMB control number for this information collection is 1890-0007.

The time required to complete this information collection is estimated to average 1.5 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: Director, Grants

Policy and Oversight Staff, U.S. Department of Education, 400 Maryland Avenue, SW (Room

3652, GSA Regional Office Building No. 3), Washington, DC 20202-4248.

NAME OF APPLICANT PROJECT NAME

PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

SIGNATURE DATE



PRINCIPLES OF EFFECTIVENESS

(1) IN GENERAL- For a program or activity developed pursuant to this part to meet the principles of effectiveness, such program or activity shall —

(A) be based upon an assessment of objective data regarding the need for

before and after school programs (including during summer recess

periods) and activities in the schools and communities;

(B) be based upon an established set of performance measures aimed at

ensuring the availability of high quality academic enrichment

opportunities; and

(C) if appropriate, be based upon scientifically based research that provides evidence that the program or activity will help students meet

the State and local student academic achievement standards.


Appendix B

I. Evidence of having met goals and objectives.



Appendix B

II. Having improved student achievement.




Appendix B

III. Evidence of utilizing collaborating partners to enhance academic performance, achievement and positive youth development.



Appendix B

IV. Evidence of collaboration with the school(s) that students attend.



Appendix D

VERIFICATION OF PRIVATE SCHOOL CONSULTATION

According to the non-regulatory guidance for 21 st CCLC, a public school or other public or private organization that is awarded a grant must provide equitable services to private school students, and their families. In designing a program that meets this requirement, grantees must provide comparable opportunities for the participation of both public- and private-school students in the attendance area served by the grant. Grantees must consult with private school officials during the design and development of the 21st CCLC program on issues such as how the children's needs will be identified and what services will be offered. Services and benefits provided to private school students must be secular, neutral, and non-ideological. This communication must be verified by completing the form below. Double-click on the cell to enter information.

Private School Name

Private School

Administrator Name and

Email Address

Date and

Method of

Contact

Participation in Program

Yes or No

Reason for Not

Participating

* Private schools whose students will participate in the program should be listed on the Summary and Abstract form as a participating school.

_______There are no private schools in the attendance area(s) of the school(s) to be served by this grant.

Applicant Signature: _______________________________ Date: _________________________

County Superintendent (s) of Schools: __________________________ Date: __ ___________

__________________________ Date: ______________

__________________________ Date: _____________



Appendix E

Verification of Sharing Intent/Application with Community

To comply with ESEA Title IV Part B Section 4204 (b)(2)(L), each applicant must sign an assurance that the community was given notice of its intent to submit an application and that the application and any waiver request be available for public review after submission of the application. To verify that this has been done, please complete the form below:

Please explain how the community was informed:

Applicant Signature: _______________________________ Date: __________________



Appendix F

Evidence of Joint Planning with Co-Applicants

In determining whether an application has been “submitted jointly,” States should look for evidence in the application that the LEA and at least one other organization collaborated in the planning and design of the program, each have substantial roles to play in the delivery of services, share grant resources to carry out those roles, and have significant ongoing involvement in the management and oversight of the program. States may want to consider what organization(s) wrote the application, what organization will be the fiscal agent, whether there is a history of these organizations working together, and whether there is evidence in the application of integration of the after-school program activities with the regular school day program. Letters of endorsement are not by themselves sufficient evidence that organizations or school districts have substantially been involved in the design of a program. (This clarification comes from the USDOE Nonregulatory Guidance for 21 st

CCLC programs.)

Evidence such as meeting agendas, sign-in sheets and planning documents should be included in the pages after the Appendix F signature sheet.

Applicant Signature: _______________________________

List of what will be done by the lead, the co-applicant partner, and both.

Date: __________________



Goal 1:

Objectives

(Specific,

Measurable,

Achievable, Realistic,

and Time-bound)

Activities

(what we do to achieve

objectives/goals)

1.1

1.2

1.3

1.1.1

1.1.2

1.1.3

1.2.1

1.2.2

1.2.3

1.3.1

1.3.2

1.3.3

Inputs/Resources

(human, financial, technology, etc… resources needed

for activities)

Outputs

(tangible and direct products of activities that lead to desired

outcomes)

1.1.1

1.1.2

1.1.3

1.2.1

1.2.2

1.2.3

1.1.1

1.1.2

1.1.3

1.2.1

1.2.2

1.2.3

Outcomes

(short-, medium-, and long- term desired results

of activities)

Indicator/Data

Source

(indicators we look for to measure implementation, progress and

success)

1.3.1

1.3.2

1.3.3

1.3.1

1.3.2

1.3.3



Goal 2:

Objectives

(Specific,

Measurable,

Achievable,

Realistic, and Timebound)

2.1

2.2

2.3

2.4

2.3.1

2.3.2

2.4.1

2.4.2

2.1.1

2.2.2

2.1.3

2.2.1

2.2.2

Activities

(what we do to achieve objectives/goals)


(human, financial, technology, etc… resources needed for activities)

Outputs

(tangible and direct products of activities that lead to desired outcomes)

Outcomes

(short-, medium-, and long- term desired results of activities)

Indicator/Data

Source

(indicators we look for to measure implementation, progress and

success)

2.1.1

2.2.2

2.1.3

2.2.1

2.2.2

2.3.1

2.3.2

2.1.1

2.2.2

2.1.3

2.2.1

2.2.2

2.3.1

2.3.2

2.4.1

2.4.2

2.4.1

2.4.2



Example of a Well-Completed CCLC Project Logic Model

Goal 1: To increase academic achievement among regular student attendees on an annual basis.

Objectives

(Specific, Measurable,

Achievable, Realistic, and Time-

bound)

Activities




(human, financial, technology, etc… resources needed for

activities)

Outputs

(tangible and direct products of activities that

lead to desired outcomes)

Outcomes

(short-, medium-, and long- term desired results of

activities)

Indicator/Data

Source

(indicators we look for to measure implementation,

progress and success)

1.1 – By spring 2017, at least

70% of all students enrolled in participating schools will attend the CCLC for a minimum of 20 days/year, with at least 50% of students attending at least 30 days.

1.1.1 – Teachers and CCLC staff provide targeted, ongoing outreach to encourage CCLC attendance

1.1.2 – Participating students and their guardians sign attendance agreement

1.1.3 – Parents and students are given a voice into CCLC activities to support ownership, relevance to participants, and enthusiasm.

1.1.4 – CCLC outreach is consistent, supportive, and regular via multiple channels.

Human: RESA 2

Project Director, 2

Site Coordinators, 6 teacher/tutors

Technology: iPads

Enrichment supplies

Transportation: busing

1.2 – At least 55% of students who attend CCLC for at least 30 days will increase their reading scores by 5% on the


1.2.1 – Students meet with tutors to establish unique literacy and reading goals and a plan to achieve them.

Human: teachers/tutors

Technology: iPads,

CCLC website developed/regularly updated.

Social media for CCLC:

Facebook

Attendance agreement drafted and shared with students & guardians for signing.

Student and parent surveys written.

Outreach materials written/created and distributed: press releases, mailings, email scripts, flyers, posters, and brochures.

Daily literacy and language arts tutoring logs updated by tutors.

95% of parents sign and students sign attendance agreement.

Daily attendance shows evidence of consistent improvement.

Student attendance at CCLC remains stable or increases every quarter.

Daily progress made in language arts and reading.

CCLC attendance

Records

Student Surveys

Acuity

SRI

Acuity/Scholastic Reading

Inventory or DIBELS from

October 2016 to spring 2017.

1.2.2 – Students will receive daily 1:1 individualized academic tutoring in literacy, language arts, and reading.

1.2.3 – Acuity/SRI is administered; progress mapped for each student.

Read180, etc.

Tutoring supplies iPad apps utilized for reading and language arts


DIBELS

Tutoring Logs

1.3 – By October 2017, at least

50% of all regular attendees will be performing at grade level

(proficient) in reading as measured by the WESTEST 2.

1.4 – At least 55% of students who attend for at least 30 days will increase their math scores by a minimum of 5% as measured by Acuity benchmarking from

October 2016 to spring 2017.

1.5 By October 2017, at least

45% of all regular attendees will be performing at grade level

(proficient) in math as measured by the WESTEST 2.

1.3.1 – Students meet with tutors to establish unique literacy and reading goals plus a plan to achieve them.

1.3.2 – Students will receive daily, 1:1, individualized academic tutoring in literacy, language arts, and reading.

1.3.3 WESTEST is administered; results are longitudinally compared to past year’s results per student.

1.4.1 – Students meet with tutors to establish unique math goals plus a plan to achieve them.

1.4.2 – Students receive daily,

1:1, individualized academic tutoring in math.

1.4.3 – STEAM and PBL embedded into math activities to the extent possible.

1.5.1 Students meet with tutors to establish unique math goals plus a plan to achieve them.

1.5.2 Students will receive daily,

1:1, individualized academic tutoring in math.

Human

(teacher/tutors)

Technology (iPads,

Read 180, etc.)

Tutoring supplies

Daily Literacy and language arts tutoring logs updated by tutors. iPad apps utilized for reading and language arts

WESTEST administered.

Evaluation matrices developed as-needed for reading assessment.

Human

(teacher/tutors)

Technology (iPads, math apps, STEAMrelated resources, etc.)

STEAM and projectbased learning supplies.

Daily math tutoring logs updated by tutors. iPad apps utilized for math

Acuity benchmarking administered.

Evaluation matrices developed as-needed for math assessment.

Human

(teacher/tutors)

Technology (iPads, math apps, STEAMrelated resources,

Daily math tutoring logs updated by tutors. iPad apps utilized for math

WESTEST administered.

Daily progress made in language arts and reading.

Daily progress made in math homework, quizzes, exams, etc.

STEAM and project-based learning activities integrate math and reflect local curriculum.

Daily progress made in math homework, quizzes, exams, etc.


WESTEST 2

Acuity benchmarking

WESTEST 2


1.6 By spring 2017, at least 75% of all regular attendees will demonstrate improved homework completion and class participation. (As measured by homework completion matrix, teacher survey, After School

Matters survey.)

1.6.1 Students are referred for

CCLC support by classroom teachers, parents, and counselors.

1.6.2 CCLC Tutors develop individual progress folders for each student and outline specific unique learning goals based on each student’s needs.

1.6.3 Students will receive 1-2 hours of 1:1 homework assistance from tutors daily at each site, based on need.

1.6.4 Students attend enrichment modules and recreation based on interests

1.6.5 Project-based learning and

STEAM embedded in afterschool activities.

Human: all CCLC staff, especially enrichment module leaders

Enrichment supplies

(arts and crafts, recreation, STEAM, etc.).

Tutoring supplies, including technology.

Busing home.

1.7 By spring 2017 at least 75% of regular employees will demonstrate improvement in behavior. (As measured by school disciplinary records).

1.5.3 WESTEST is administered; results are longitudinally compared to past year’s results per student.

1.7.1 Students attending CCLC participate in enrichment and

PBL activities including (1) social skill development and service learning; (2) art, music, drama, recreation; (3) entrepreneurship; and (4) other etc.)

STEAM and projectbased learning supplies

Human all CCLC staff, especially enrichment module leaders

Enrichment supplies

(arts and crafts,

Evaluation matrices developed as-needed for math assessment.

STEAM, tutoring, and project-based learning activities integrate math and reflect local curriculum and instructional strategies.

Student enrichment interest surveys developed and administered. Results tabulated and shared with

CCLC staff.

List of potential enrichment module leaders compiled.

Communication/outreach with potential adult enrichment modules documented (email, phone records)

Background checks completed. Supplies purchased (receipts = evidence)

Enrichment schedules updated.

Student engagement matrices developed for classroom teachers to track daily homework completion and participation rates.

Surveys developed for classroom teachers.

Student enrichment interest surveys developed and administered.

Results tabulated and shared with CCLC staff.

Daily homework completion logs show improvement.

Enrichment and recreation modules boost student attendance, interest, engagement,

and enthusiasm for learning.

Daily behavior tacking shows improvement.

Student code-ofconduct referrals decrease.

Homework completion matrix, class participation survey

(teacher completed),

After School Matters survey.


Request for Proposal Document 51 interest-based activities.

1.7.2 Students are given a voice to provide feedback into CCLC activities. recreating, STEAM etc.).

Tutoring supplies, including technology.

Busing Home

List of potential enrichment module leaders compiled.

Communication/outreach with potential adult enrichment modules documented (email, phone records).

Background checks completed.

Supplies purchased (receipts

= evidence)

Enrichment schedules updated.

Student engagement matrices developed for classroom teachers to track daily homework completion and participation rates.

Surveys developed for classroom teachers.

Out-of-school suspensions decrease.

In-school suspensions decrease.

Enrichment and recreation modules boost student attendance, interest, engagement, and enthusiasm for learning.



Objectives

(Specific,

Measurable,

Achievable, Realistic,

and Time-bound)

Goal 2

:

To increase the education and skill level of adults and parents.

Activities




(human, financial, technology, etc… resources needed for

activities)

Outputs

(tangible and direct products of activities that

lead to desired outcomes)

Outcomes

(short-, medium-, and long- term desired

results of activities)

Indicator/Data Source

(indicators we look for to measure implementation,

progress and success)

2.1 By spring 2017, at least 85% of parents/adults who have participated in adult CCLC programs will report increased family-school connectedness as well as improved skills and knowledge in the specific program in which they participated.

2.2 By spring 2017 at least 85% of parents will report that CCLC services are helpful, accessible,

2.1.1 Parents are surveyed to determine interests, schedules and availability.

2.1.2 Existing classes identified, meeting scheduled with staff and partners.

2.1.3 New classes designed and scheduled, based on survey feedback.

2.1.4 Publicity is targeted and stresses benefits to adult participants.

2.1.5 Surveys and focus groups are designed and administered pre-and post-events.

2.2.1 Adult activities are scheduled based on participant feedback on convenience schedules.

Human: instructors of adult programming, CCLC Director to coordinate and conduct outreach,

Site supervision of extended hours at computer labs and libraries.

Financial: purchase of resources, supplies and consumables.

Human: instructors of adult programming, CCLC Director to coordinate and conduct outreach,

Site supervision of extended hours at computer labs and libraries.

Pre-and post-surveys developed and administered to determinate areas of adult interest and need.

Existing classes identified, meeting with scheduled staff and partners (meeting minutes, lists)

Outreach strategies analyzed and improved to increase attendance

(meeting minutes, lists, brochures, mailings).

Electronic medial updated (social mediate, websites).

New programs developed and scheduled (instructor contracts, schedule posted via identified venues)

Pre-and post-surveys developed and administered to determine areas of adult interest and need.

Adult attendance at

CCLC-coordinated programs at least 60% of anticipated.

Attendee recommendations contribute to continual improvement.

Families report increased school engagement.

More parents volunteering at school

More parents attending conferences and school events.

More adults completing

GEDs and other postsecondary coursework.

Adult literacy rates increase.

Adult attendance at

CCLC-coordinated programs at least 60% of anticipated.

Participant surveys

Focus group results

Adult literacy measures

Attendance logs

Event feedback forms

Participant surveys

Focus group results

Attendance logs


Request for Proposal Document 53 conveniently scheduled, and targeted to their needs.

2.2.2 Adult services are designated around participant interests and needs.

2.2.3 Surveys and focus groups are designed and administered pre and post-events.

Financial: purchase of resources, supplies, and consumables

Existing classes identified, meeting scheduled with staff and partners (meeting minutes, lists)

Outreach strategies analyzed and improved to increase attendance

(meeting minutes, lists, brochures, mailings).

Electronic media updated

(social media, websites).

New programs developed and scheduled (instructor contracts, schedule posted via identified venues)

Adult attendance remains stable or increases each quarter.

Attendee recommendations contribute to continual improvement.

Families report increased school engagement.

More parents volunteering at school.

More parents attending conferences and school events.

More adults completing

GEDs and other postsecondary coursework.

Adult literacy rates increase.

Event feedback forms



2016 21 ST CENTURY COMMUNITY LEARNING CENTER GRANT

COMPETITION

NOTIFICATION OF INTENT TO APPLY

DUE APRIL 1 st

The following organization will be submitting a 21 st Century Community Learning

Center Grant application:

Name of Organization :

Lead Administrator Name :

Email:

Phone:

Grant Application Contact Name :

Email:

Phone:

Number of Applications:

Individual Submitting Form:

Email (if different from any above):

A list of all organizations intending to submit a 2016 application will be emailed to organizations submitting this form. If you submit the intent form and later decide not to apply, it would be greatly appreciated if you would send an email informing Benitez Jackson at bljackso@k12.wv.us

. Having an accurate number of applications to be scored helps secure the appropriate number of reviewers.


Application Package

Application Package

Appendix B

Appendix B

Appendix B

Appendix B

Appendix D

Appendix E

Appendix F

Example of a Well-Completed CCLC Project Logic Model

Goal 1: To increase academic achievement among regular student attendees on an annual basis.

Goal 2

To increase the education and skill level of adults and parents.

Related documents

Products

Support

Application Package

Application Package

Appendix B

Appendix B

Appendix B

Appendix B

Appendix D

Appendix E

Appendix F

Example of a Well-Completed CCLC Project Logic Model

Goal 1: To increase academic achievement among regular student attendees on an annual basis.

Goal 2

To increase the education and skill level of adults and parents.

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