Name of Grant Program: Massachusetts 21st Century Community Learning
Centers – Summer Enhancement Grant
Fund Code: 647-B4
PART III – REQUIRED PROGRAM INFORMATION
A. District/Program Information
District/Entity:
Program Coordinator:
Email Address:
Sites included in this
application
Site #1
Site #2 (If applicable)
Complete funding information in this chart below ONLY IF applying for more than one site
Base amount of funds requested
Up to $20,000/site
(If applicable) Total additional funds requested
(Up to $5,000/site for Option 1 or up to $12,500/site for Option 2).
Total
FY15 21st CCLC Fund Code 647-A/B2 grant funds to be used to support the
enhanced summer program.
Total Value of In-Kind Services
Total
other funding sources (non 21st CCLC)
Total Program cost
$
$
$
$
$
$
1. Describe the planning process and the resources and/or expertise utilized. Address each of the following
in your response.
a. Describe the current district vision and goals for summer programming and how it connects to and
supports the program described in this application.
b. Identify the needs and priorities that this grant will impact (e.g., academic, social-emotional,
wellness, etc.). If applicable, include the reason(s) for prioritizing the chosen site(s) proposed to be
enhanced.
c. Describe how the enhanced summer program will collaborate with other district/school summer
initiatives in order to align and leverage resources, improve program quality, and develop shared
outcomes for success.
d. Describe the actual investments of the lead organization, and other funding sources that will be
leveraged to supplement the grant award and to support services. Please Note: Use of space for the
school site in which the program is held is not considered in-kind. However, use of space or facilities
in the community can be listed.
2. Programs must offer a daily nutritious snack, breakfast (if applicable) and lunch that meets the requirement
of the United States Department of Agriculture (USDA) National School Lunch Program. Confirm that
these will be provided.
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Name of Grant Program: Massachusetts 21st Century Community Learning
Centers – Summer Enhancement Grant
Fund Code: 647-B4
B. Site Specific Information
Instructions: Please address each of the following questions within the indicated word/page limits for each
site. Responses should be provided within this document, without changing the format or font size, and
leaving the questions above each response.
Site
Coordinator:
Site Name:
Email Address:
Number of unduplicated students served during the
summer of 2014
Total number of unduplicated students expected to be served
during the summer of 2015
Total number of
hours offered in
summer of 2014
Total number of
weeks offered in
summer of 2014
Total Number of
hours to be
offered in
summer of 2015
Additional Funding Options
(place an X in the appropriate box,
if applicable)
Total number of
weeks to be
offered in summer
of 2015
Option 1
Interdisciplinary
Curriculum Development
Percentage
increase of time
from summer of
2014 to 2015
Option 2
Service-Learning
Curriculum Development
Base amount of funds requested
Up to $20,000
(If applicable) Total additional funds requested
(Up to $5,000 for Option 1 or up to $12,500 for Option 2.)
Total amount of FY15 21st CCLC Fund Code 647-A or 647-B2
grant funds to be used
Total value of in-kind services
$
Total of other funding sources (non 21st CCLC)
$
Total program cost (sum the above five boxes)
$
Projected cost per pupil served
(Projected students to be served / Total program cost)
$
$
$
$
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Name of Grant Program: Massachusetts 21st Century Community Learning
Centers – Summer Enhancement Grant
Fund Code: 647-B4
1. HOURS OF OPERATION (1 page maximum)
a. Describe the plan for adding the additional hours and the rationale for the selection.
b. Use the chart below to provide the proposed daily hours of operation for the proposed site.
Program Dates
Program Times
Start Date:
From:
End Date:
To:
Days of week
Mon
Tues
Wed
Thurs
Fri
\
2. PROGRAM DEVELOPMENT AND IMPLEMENTATION (5 page maximum)
Provide the following information about the program and services that will be delivered.
a. Project Narrative: Provide a brief narrative in 300 words or less of what a typical day will look like in
the proposed summer program.
b. Student Outreach: Describe planned strategies for student outreach and sustained attendance
levels that will ensure that the target population (students in high need groups and those in need of
additional supports) will be served and meet the required 80% average attendance hours. Reminder:
students must enroll and participate for the entire length of the summer program.
c. Program Design:
o
Describe in detail how the program will build on the success of both the summer of 2014 and the
FY15 school year program. Include the primary focus (foci) of the summer program [e.g., SL,
Science, Technology, Engineering & Mathematics (STEM), 3rd grade reading, literacy, school
transition support, college and career awareness, etc.].
o
Describe plans to provide innovative academic enrichment (cohesive blending of academic
learning and enrichment activities) using the “Planned Activities” chart found on the next page.
c.i. Additional Funding Option 1 - Curriculum Development Applicants ONLY
Applicants selecting this option will develop, pilot, and document interdisciplinary curricula that is projectbased and supports either ELA or Mathematics.
o Provide a short, but clear, description of the proposed idea for development of curriculum to be
implemented during the enhanced summer program. Include the number of staff involved, their
backgrounds and expertise. (Please note these should be the same teachers that will be
involved in implementing the curriculum.)
o
Provide a timeline for curriculum planning and development.
c.ii. Additional Funding Option 2 - SL Curriculum Development Applicants ONLY
Applicants selecting the SL option will work with the Department to develop, pilot, and document an SL
Curricula that incorporates strong academic rigor, student ownership, and community partnerships. The
specifics related to topics students will explore and projects they will implement will be developed as part
of this process. (See the Additional Funding Options section of the Funding Opportunity RFP for required
PD schedule.)
o
List the 3-5 team members who will attend professional development/coaching sessions.
NOTE: Teachers who will be involved in delivering services to students during the summer
program should be included on this team.
o
Describe how the district/lead applicant will support/provide planning time prior to the summer
program for staff to integrate information from the PD/training/TA provided, and to develop plans
to implement the SL component. (Grant funds may be requested to cover these costs.)
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Name of Grant Program: Massachusetts 21st Century Community Learning Centers – Summer Enhancement Grant
Fund Code: 647-B4
Planned Activities
Use the chart below to describe creative and innovative practices that will be enhanced or added as a result of this funding.
Academic Enrichment and Engaging Instructional Practices: These practices should be thoughtfully planned so as to deepen student
engagement, integrate academics though cross curricular programming, support social emotional needs, and build 21st Century skills. Please
consider this when formulating your response.
Note: Applicants choosing Option 2 – SL Curriculum Development do not need to include information about the SL curriculum to be developed
here; please only include information about other planned academic enrichment activities that will be offered during the program.
Provide brief descriptions/examples of planned, enhanced, or new academic enrichment
opportunities that will be offered during the summer of 2015 (add rows as needed).
For each opportunity, please include a description of:
 The engaging instructional strategies to be used.
 How the offering meets an identified need/gap in services.
 Specific examples of ways in which the learning and developmental needs of the participants
will be supported.
Content Area(s)
Addressed
Indicate whether
offering is:
 Existing
 Enhanced
 New
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Name of Grant Program: Massachusetts 21st Century Community Learning
Centers – Summer Enhancement Grant
Fund Code: 647-B4
3. Staff Qualifications (1 page maximum)
a. Describe the staffing for proposed program and services. Include the following:
o
plans for quality personnel recruitment and retention;
o
how the applicant will ensure that staff have the necessary qualifications to meet the diverse
needs of the target population;
o
student: staff ratios; and
o
amount of planning time provided per hour of teaching.
b. Complete the charts below detailing staff credentials.
Type of staff that will be utilized (Check all that apply):
School day
School day
Out-of-School Time
full-time
part-time
Educators
Other
(please specify)
Indicate the projected number of certified teachers in the following areas:
Math
ELA
Science
Art
History/
Soc. Sci.
Health/PE
Other (List
Licensure)
4. COMMUNITY PARTNERSHIPS/CONTRACTED PROVIDERS (1 page maximum)
a. Describe the current partnerships as they relate to the implementation of the summer program.
b. If, applicable describe plans to cultivate new or expand opportunities for building and strengthening
partnerships. (Note: SL Curriculum Development applicants may have some ideas about new,
expanded partnerships, but will develop these more fully as part of the curriculum development
process.)
c. If applicable, describe the criteria that was (or will be) used in the selecting contracted providers.
d. Complete the chart below:
Partner/Contractor Name
Partners/Outside Contractors
Area of Expertise/Role in Summer Program
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Name of Grant Program: Massachusetts 21st Century Community Learning
Centers – Summer Enhancement Grant
Fund Code: 647-B4
5. PROFESSIONAL DEVELOPMENT (1 page maximum)
The Department is dedicated to helping educators improve their practice through participation in High Quality
Professional Development (HQPD). High Quality Professional Development is a set of coherent learning
experiences that is systematic, purposeful, and structured over a sustained period of time with the goal of
improving teacher practice and student outcomes.
a. Describe the types of professional development that will be provided to staff, partners, and providers
in order to improve practices. Note: Sites selecting Option 2 – SL Curriculum Development do not
need to respond to this question, unless they are offering PD opportunities other than those
designed to support SL Curriculum Development. Include the following:

Total number of hours of professional development to be provided; and

The amount of planning time to be provided. Note if partners and contractors will be
participating in common planning time with program staff.
b. If applicable, describe how qualified volunteers will be used to support the proposed activities.
6. ACCOUNTABILITY AND EVALUATION (1 page maximum)
Grantees are required to use the Survey of Academic Youth Outcomes (SAYO) evaluation instrument.
Additionally, recipients will be required to participate in an evaluation that will look at the effects of summer
learning on student achievement.
a. Select the academic outcomes the program will be measuring. From the list of outcomes below,
select one (1) academic outcome and two (2) intermediary outcomes. Learning skills is an additional
required outcome. The district and school curricular priorities, school improvement plan, and
students’ needs should guide the items selected.
Academic Outcomes (Select one outcome)
Content Area
Select 1
Mathematics
English/Language Arts
Intermediary Outcomes (select two outcomes plus learning skills)
Outcome Area
1. Learning Skills (understands academic concepts)
2. Behavior (includes ability to function within the classroom community, follows rules and
limits, and accepts consequences)
Select 2
X
3. Engagement in learning (includes staying on task, interested in learning new things,
and participates in classroom activities)
4. Initiative (includes persistence on tasks, takes initiative to get information and
resources needed to accomplish work, and takes responsibility for own self)
5. Problem-Solving Skills (includes analytical skills, prioritizing, planning, and problem
solving/decision making)
6. Communication (includes listening skills, oral presentation skills, and verbal skills)
7. Relations with Adults (includes discussing interests or ideas, showing respect, and
seeking assistance)
8. Relationships with peers
b. Address the process used in selecting the academic outcomes and how they support the district and
school curricular priorities, school improvement plans, and students’ needs.
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Name of Grant Program: Massachusetts 21st Century Community Learning
Centers – Summer Enhancement Grant
Fund Code: 647-B4
7. TIMELINES (1 page maximum)
Include a brief timeline for continued program planning and coordination activities.
8. BUDGET/BUDGET NARRATIVE
Use the Part II - Budget (II-A) and Budget Narrative (II-B) Excel Workbook provided in the Funding
Opportunity RFP’s Required Forms section.
Program Expenditures
In constructing the budget, please note that all costs must be reasonable and necessary to implement the
program activities. Applicants must complete both a school year (upon approval –June 30, 2015) and
summer budget (July 1- August 31, 2015), and a budget narrative for each (if applying for funds during the
school year as well as summer time period) that demonstrates clear and specific links to the project activity
plan. No more than 10% of the total budget may be used for materials and supplies.
Funds allocated under this federally funded grant program may be used only to supplement, not supplant,
funds that local educational agencies, schools, and community-based organizations would otherwise expend
for extended learning opportunities including summer. Rental of space, cash stipends to students to attend
the program, cell phones, telephone and utilities, overhead costs and the purchase of materials that are
used during the school day are not allowable expenses under this grant.
Please Note: If you plan to use funds to hire contracted providers you must include a detailed budget and
narrative for each contractor.
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