Name of Grant Program: Massachusetts 21st Century Community Learning
Centers Program Continuation Grants
Fund Code: 647-A / 245-A
PART III-A REQUIRED PROGRAM INFORMATION
FISCAL YEAR 2014-2015 (FY15)
In order to consolidate the continuation grant process for grantees that receive 21 st CCLC funds through multiple
fund codes, there is one continuation application this year for recipients of any the following:
 Competitive new sites through FY13 FC 647-B1 (OST) and FY14 FC 647-B1A (ELT) and B1B (OST)
 Competitive exemplary programs grants through FY13 and FY14 FC 647-B2
 Non-competitive enhanced programs for students with disabilities through FY13 and FY14 FC 245-B
INSTRUCTIONS: All applicants should respond to pages 1-8 (the Program Summary Information and Sections
I-VIII). Pages 9-10 of this document (Section IX) is only required for applicants requesting FC 245-A; it requests
information regarding students served with these enhancement grant funds.
DUE DATE REMINDER: This Part III-A document is due with the July 25, 2014 portion
(See Funding Opportunity RFP Due Date and submission instruction sections for more details).
PROGRAM SUMMARY INFORMATION:
School District /
Applicant Agency:
Program Coordinator /
Contact:
Phone:
Email:
Total Number of
FC 647-A sites for which
you are applying for
continuation funding.
Total Number of
FC 245-A sites for which
you are applying for
continuation funding.
Amount requested for 9/1/2014 - 6/31/2015:
$
Amount requested for 7/1/2015 - 8/31/2014:
$
TOTAL REQUESTED FOR FC 647-A
$
Amount requested for 9/1/2014-6/31/2015:
$
Amount requested for 7/1/2015-8/31/2015:
$
TOTAL REQUESTED FOR FC 245-A
$
In the cells below please list the names of all the sites for which you are applying for continuation funding through
FY FC 647-A/245-A under the year in which they were originally funded, and their anticipated FY15 start dates.
FY13 647-B1 site(s)
FY14 647-B1B
(OST) site
Anticipated
FY15 Start Date
Anticipated
FY15 Start Date
FY14 647-B1A
(ELT) site(s)
FY13 647-B2 Site(s)
Anticipated
FY15 Start Date
Anticipated
FY15 Start Date
FY14 647-B2
Site(s)
Anticipated
FY15 Start Date
FY13 245-B Sites:
(requesting FY15 FC 245-A funds)
FY14 245-B Sites:
(requesting FY15 FC 245-A funds)
For FY13 21ST CCLC-OST New Site Grantees ALSO AWARDED AN FY14 21ST CCLC-ELT New Site grant
FOR THE SAME SCHOOL SITE, and approved for using some OST funds for ELT.* What percentage of
FY15 FY13 OST continuation grants funds are being requested for use during the expanded school day?
This should be consistent with what was approved in FY14.
*This box is only applicable to one grantee (Lawrence Public Schools - Parthum Elementary School).
Name of Grant Program: Massachusetts 21st Century Community Learning
Centers Program Continuation Grants
Fund Code: 647-A / 245-A
Please complete the charts below for each school/site for which you are applying for FY15 FC 647-A.
I. SCHOOL/SITE DATA REPORTING
(COPY AND PASTE THE CHART TO COMPLETE FOR EACH SITE)
OST
ELT
SITE NAME
Number of
Students Served
OST
ELT (if all
indicate so)
Is this site also
receiving
FC 245-A funds?
(OST only) (Y/N)
OST
Mean Hours
ELT
ALL OST SITES SHOULD COMPLETE THE CHARTS BELOW
(For ELT sites: If a subset of your total student enrollment was served,
please complete all but the SAYO information below.)
Grade
K
1
2
3
4
5
6
7
8
9
10
11
12
%
Served
% SPED
% LowIncome
ELA MCAS DATA
% ELL
Out of All
Students Served
MATH MCAS DATA
% below Proficient (<240)
Social
Sci.
Out of All Students
Served
% below Proficient (<240)
Sci.
SAYO ACADEMIC
ELA/
ELA/Verbal
Comm.
Read.
ELA/ Written
Comm.
Math
# Students
Pre Mean
Post Mean
% Change
Pre to Post
SAYO- T
HW
Behavior
Initiative
Engagement
Prob.Solv.
Comm
Rel.
Adults
# Students
% Change
Pre to Post
SAYO-S
Learning
Skills
Beh.
Initiative
Engag.
Prob.
Solv.
Comm.
Rel.
Peers
Rel.
Adults
# Students
% Change
Pre to Post
2
Name of Grant Program: Massachusetts 21st Century Community Learning
Centers Program Continuation Grants
Fund Code: 647-A / 245-A
I. SCHOOL/SITE DATA REPORTING – continued (for each site)
1. Describe the methods used to collect data, the sample size, and important characteristics about the
sample (e.g., number of youth sampled from each grade, number of English Language Learners (ELL),
free and reduced lunch, special education, etc.). Provide this information about only those sites included in
this application.
2. What does the SAYO data suggest about what may or may not be working at each funded site? Keep the
following in mind when crafting your response:

Did any outcomes have particularly high percentage changes (> 25 percent)? If so, what might
this suggest about the data?

Did any outcomes have zero or negative percentage changes? If so what might this suggest?

In addition to looking at the results for participants overall, consider examining whether results
varied by differing groups of children, e.g., children/youth with high or low participation rates,
with special needs, English language learners, etc.
3. Based on the information provided in the Mid-year Report Summary Chart and Action Planning
Template, what were the area(s) each site prioritized for improvement? Were the sites able to
accomplish the desired change(s)?

If so, describe the strategies used; and

If not, explain why and describe the process staff at each site will engage in to create a plan to
address these areas of need?
Note ONLY OST sites need to respond to questions 4-7 (ELT sites skip to question 8).
4. Was each site able to reach the projected number of participants? If not, explain why and how this will be
addressed in the coming year.
5. Based on the demographic data provided in the grant application did each site reach a high percentage of
the targeted students that this grant was intended to serve? If not, explain why and how this will be
addressed in the coming year.
6. Did each site meet the required minimum of 448 hours of operation for the school year and summer? If not,
how many hours were offered, explain why and how this will be addressed in the coming year.
7. Did each site meet the minimum required 80 average hours of attendance for high school, 90 for middle
school and 100 for elementary? If not, explain why and how this will be addressed in the coming year.
8. [OST and ELT sites should respond to question 8] Describe the process used to implement the APT
(Assessment of Program Practices Tool). Include the following information (Reminder 21st CCLC grantees
were required to implement the APT across all funded sites).
a. Describe how the observation team(s) were selected, and the types of individuals participating.
b. Note how often and for how long observations were conducted.
c.
Include a synopsis of the results of the findings.
d. Describe the process used to provide feedback and technical assistance to program staff including
teachers that may also work in the school day and contracted providers.
e. In addition to the full APT-O (Self Assessment Observation Tool), grantees are also required to
implement the APT-Q (Program Questionnaire). Provide a synopsis of the findings.
f.
Describe plans to implement both the APT-O and APT-Q across all funded sites in FY15.
3
Name of Grant Program: Massachusetts 21st Century Community Learning
Centers Program Continuation Grants
Fund Code: 647-A / 245-A
II. PROGRAMMING FY14
Responses to the following questions should build on the information provided in the Mid-year Report Summary
Chart and Action Planning Template, and be supported with findings from SAYO, APT, and other quantitative and
qualitative data).
For each funded site:
1. Programmatically what worked well this year? (Note evidence to support the answer.)
2. Programmatically what did not work well this year, or did not work as well as intended? What inquiry or
reflective process did the staff engage in to address this and what changes will be made as a result?
3. If the site(s) offer blended learning, academic support, and/or homework support describe how the time
was used to assist students with better understanding content.
4. Describe how the site(s) supported and will continue to support college and career readiness for
participating students.
III. STAFF/STAFF DEVELOPMENT
1.
Complete the chart below indicating the credentials for all staff that implemented 21st CCLC programming
during FY14 (Add additional rows as needed.)
INDICATE THE NUMBER OF TEACHERS/EDUCATORS IN EACH OF THE FOLLOWING AREAS THAT PROVIDED DIRECT SERVICES
TO STUDENTS PARTICIPATING IN 21STCCLC FUNDED ACTIVITIES:
TEACHERS CERTIFIED IN: (COUNT DUAL/MULTI-CERTIFIED TEACHERS IN ALL APPLICABLE CATEGORIES)
M ATH ELA SCIENCE ART
SOCIAL
HEALTH/
SPED
OTHER
OST
School/Site
STUDIES
PE
(LIST
LICENSURE)
2. Describe how each site made effective use of the professional development, training and other resources
provided in FY14 through the 21st CCLC program. Indicate specific trainings staff attended, and how the
resources or information provided was utilized, implemented, and/or shared across the site(s).
3. Indicate if any of the sites included in this application received mentoring and/or peer support in FY14 from
another 21st CCLC program. If yes, please describe ways in which the coordinator and/or program staff
benefitted.
4. Indicate if the program(s) provided any of the following. Check all that apply.
a. ___ Staff planning time: The Department strongly recommends providing planning time. If yes, indicate
how much time is allotted.
b. ___ Staff meetings: If yes, indicate how many and how frequently they were held. List a sample of
topics discussed this past year.
c. ___ Professional development (specific to the 21st CCLC program): If checked please describe the
PD offered.
5. Indicate if the program coordinator or staff participate in the Department sponsored regional network
meetings. If yes, describe how s/he benefitted from them.
6. For each site that participated in state, regional, or local PD/training - describe a specific project, program,
or strategy that was implemented in FY14 as a result. Please cite the training(s) attended and if it was a
state, regional, or locally sponsored workshop (e.g. service-learning, promising practices forum, FitMath
Scratch, etc.).
7. Indicate if the program(s) have utilized the Contextual Learning Portal. If yes, indicate if the resources
have been useful. Please offer any suggestions as to how the site can be made to be of more use to
program staff.
4
Name of Grant Program: Massachusetts 21st Century Community Learning
Centers Program Continuation Grants
Fund Code: 647-A / 245-A
III. STAFF/STAFF DEVELOPMENT (continued)
1. 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.
While the following activities are not considered professional development they still contribute to increasing
the knowledge and expertise of program staff.
 Training: Informational sessions focused on learning discrete skills and/or performing individual tasks.
An example of training is a session on how to access a report in a database. Training is brief and has
a beginning and an end. (e.g., SAYO, APT Data trainings);
 Technical Assistance (TA): The provision of brief, targeted support with the goal of aiding the
recipient in knowledge application. Technical assistance provides advice and guidance in the use of
resources, materials and equipment. (e.g., Promising Practices Forums).
a. Describe plans in FY15 to provide any of the following:
 Professional Development (include how the program will ensure the PD supports the Department’s
HQPD)
 Training
 Technical Assistance
b. Describe plans for staff to attend FY15 Department and 21st CCLC Regional Network sponsored
professional development, trainings, or technical assistance sessions.
c. Use the chart below to list any particular type of FY15 PD, training or TA the site(s) would like to receive.
Professional Development
Training
TA
IV. PARTNERS/CONTRACTED PROVIDERS
1. Use the chart below to list the Partners/Contracted providers utilized in FY14.
PARTNER*/CONTRACTOR** NAME
PARTNERS/ CONTRACTORS
INDICATE IF PARTNER
DESCRIBE PROGRAMMING PROVIDED AND HOW
(YES/NO)
IT CONNECTED TO AND SUPPORTED STUDENT
NEEDS AND SELECTED SAYO OUTCOMES.
*Partners are defined as individuals or agencies that contribute back to the program and collaborate to achieve
mutually beneficial goals.)
**Contractors are defined as individuals or agencies that primarily receive payment for services provided.
5
Name of Grant Program: Massachusetts 21st Century Community Learning
Centers Program Continuation Grants
Fund Code: 647-A / 245-A
IV. PARTNERS/CONTRACTED PROVIDERS (continued)=
2.
If the programs partnered or contracted with outside vendors/community-based agencies, describe the
following:
 The selection criteria.
 Training or technical assistance provided.
 The process used to maintain ongoing planning and communication.
 In order to ensure providers are able to fully meet student needs, describe the system for sharing
pertinent student data (with appropriate confidentiality).
3.
Indicate if provider staff attend staff meetings or participate in collaborative planning time.
V. FOR SCHOOL DISTRICTS ONLY
As you are aware Federal law mandates that private school administrators be consulted regarding programs and
services provided through the 21st CCLC grant.
1. Indicate if your site(s) provide services to private schools or private school students in your geographic
vicinity. If yes, describe the service provided. If applicable, include the number of students served from
private schools.
VI. MENTORING / REGIONAL NETWORKS (FY13 and FY14: PROMISING, EXEMPLARY, AND
DEMONSTRATION SITES ONLY; ALL OTHERS SKIP TO SECTION VII)
1. Describe in detail how the program/staff have served as a resource, model and/or mentor during FY14.
Provide specific examples of the types of mentoring provided. Note the approximate percentage of the
program coordinator, site coordinator and or program staff time that was devoted to mentoring related
activities.
2. Describe the district’s/sites’ level of participation in the 21st CCLC regional networks.
3. Describe the specific ways in which the program will continue to serve as a mentor and/or resource in
FY15. For demonstration sites, be specific as to ways in which the site level program(s) will directly serve
in this capacity.
VII. SUSTAINABILITY
1. Describe current or potential partnerships as they relate to developing a strategy to help sustain the
program beyond the funding cycle.
2. Describe how the 21st CCLC program maximized resources by collaborating/coordinating with other
school or district initiatives such as wrap around zones(WAZ), academic support, MassGrad, MckinneyVento, Title I, Title III, etc.
3. Describe the financial resources and in-kind contributions that have been secured to support
sustainability efforts. For OST promising, exemplary, and demonstration sites, describe how the additional
resources will be leveraged to ensure the school/site will continue to operate at the same level and meet
hours of operation requirements of this grant.
4. Complete the chart on the next page listing the grant funds and the other sources described above in #3
that will be leveraged to support specific line items. Please note if funds are dedicated to specific sites.
6
Name of Grant Program: Massachusetts 21st Century Community Learning
Centers Program Continuation Grants
Fund Code: 647-A / 245-A
VII. SUSTAINABILITY (continued)
FY15
21st CCLC Funds
Funding Category
Additional source(s)
and dollar amounts
that will be
leveraged
Total
Staffing (including, but not limited
to, instructional staff, planning
time, substitutes, etc.)
Professional Development
Contracted Providers/Vendors
Materials/Supplies
Transportation
Other: (please describe below)
Total Anticipated FY15 Costs
PLEASE NOTE REGISTRATION FEES: OST Programs may charge fees provided they do not prohibit any family
from participating for financial reasons. Income generated from fees, services, or other public or private funds
must be used to fund additional costs consistent with the grant application and cannot be carried over
beyond the three year grant cycle. Use the chart above to describe projected revenues from fees and how
they will be used to support costs consistent with implementing the proposed program.
4. If the OST program plans to charge a registration fee, provide a narrative explaining the fee structure and
the process that will be used to assure that income and/or ability to pay will not deter families from enrolling
their children in the program. Additionally, describe the how the funds will be administered and managed.
Programs must be equally accessible to all students targeted for services, regardless of their ability to pay.
(See next page for VIII. BUDGET section.)
7
Name of Grant Program: Massachusetts 21st Century Community Learning
Centers Program Continuation Grants
Fund Code: 647-A / 245-A
VIII. BUDGET
Each Part II Budget Workbook (Excel file) is four pages and includes a budget and an associated budget
narrative. Submit one (School Year) Part IIA/IIB Budget/Budget Narrative Excel file for expenditures that will occur
September 1, 2014 - June 30, 2015. Submit a separate (Summer 2015) Part IIA/IIB Budget/Budget Narrative
Excel file for expenditures that will occur July 1, 2015 - August 31, 2015.
BUDGET RELATED REMINDERS:
1. For FC 245-A enhancement grant applicants, as per above, submit separate budget files for the enhancement
grant funds (one for school year expenses and one for summer expenses, if any).
2. For recipients of an FY13 FC 647-B1 grant submit:
 One school year budget workbook for the full FY15 carryover amount you have available (this equals the
full amount you were awarded in FY14 for FC 647-B1 grant, minus the final amount received for the grant).
You will need to make sure to spend all of these funds by 6/30/15 at the latest, and earlier if possible. This
budget funded through FY15 carryover dollars must be spent on the site(s) originally funded through the
FY13 FC 647-B1 grant.
 The second school year budget workbook should total the remaining amount that the continuation grant
site(s) will need from FY15 funds.
 Submit a third budget workbook for the summer time period (July-August 2015).
 The summer budget should not request the full balance of the FY15 funds, so some funding will be left to
request through an FY15 carryover budget in FY16.
3. In constructing the budgets, please make sure for all stipend positions and contracted providers to provide the
rate (hourly or flat fee) or number of staff and Full Time Equivalent (FTE) information on the budget pages.
4. All costs must be reasonable and necessary to implement program activities. Additionally, budget narratives
must demonstrate clear and specific links to the project activity plan. Please be as specific as possible
describing budgeted materials and supplies. Out of state travel is not allowed, other than for Department
approved conferences.
5. Funds allocated under this program may be used only to supplement, not supplant, funds that local schools
and community-based organizations would otherwise expend for programs of this type. 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 typically part of the school day are not allowable expenses under this grant.
6. If the budget includes contracts with any outside vendors/community-based agencies you must attach a
budget/budget narrative for each contracted provider. Contracted providers must be held to the same budget
requirements as the grantee.
7. No more than 10% of the budget may be used on materials and supplies; and no more than 22.5% of the total
budget may be used for program coordination and administration.
(See next page for IX. FOR APPLICANTS REQUESTING FC 245-A CONTINUATION GRANTS FOR
ENHANCED PROGRAMS FOR STUDENTS WITH DISABILITIES section.)
8
Name of Grant Program: Massachusetts 21st Century Community Learning
Centers Program Continuation Grants
Fund Code: 647-A / 245-A
IX. FOR APPLICANTS REQUESTING FC 245-A CONTINUATION GRANTS FOR ENHANCED PROGRAMS
FOR STUDENTS WITH DISABILITIES.
Please respond to all of the questions below, regarding students served with these funds.
A. DATA REPORTING (FC 245-A)
For each funded site:
1. Did any of the students served with funds from FC 245 in FY14 require an alternate assessment or
special accommodations in completing SAYO’s? If yes please describe the alternate assessment and/or
accommodation needed.
2. Where you able to reach the projected number of participants on an IEP? If not, explain why and how this
will be addressed in the coming year.
3. Describe how the enhancements contributed to increased achievement, healthy development, and
socialization for students on an IEP.
B. FY14 PROGRAM / FY15 PLANNING (FC 245-A)
1. Programmatically what worked well this year? Based on what evidence? Summarize at least two of the
program’s most successful accomplishments, over the past year with regards to FC 245. At least one
should be programmatic and include a project that highlights the accomplishments of the program and
provides specific examples of ways in which the learning and developmental needs of the participants
were supported. Samples of lesson plan templates, etc. may be attached to the proposal. Include plans
for continuing to support the academic and developmental needs of students on IEP’s in FY15.
2. Programmatically what did not work well this year, or did not work as well as intended? What inquiry or
reflective process did the staff engage in to address this and what changes will be made as a result?
3. Describe the process used to assure activities were fully inclusive to ensure students with disabilities
were engaged with peers without disabilities
4. Describe the process used to maintain ongoing communication and collaboration with the IEP Team chair
and/or classroom teacher(s) regarding students with IEPs served by the program.
C. STAFF DEVELOPMENT (FC 245-A)
1. If additional staff were hired to support the students on an IEP describe their credentials and role in the
program (e.g.: inclusion specialist, 1:1, etc).
2. Describe the professional development provided to staff, specific to including students on IEP’s. Included
by whom the PD/training was provided, who attended, and the overall effects on program quality.
D. SUSTAINABILITY (FC 245-A)
As noted in the FY14 continuation and non-competitive Funding Opportunity RFP documents, continued funding,
pending budget appropriations, will be available through the 21st CCLC grantee site's final year within its FC 647-A
funding cycle (for a maximum of 3 years). FY15 FC 245-A grant entities may request up to 85% of their FY14 FC
245 award (with a 15% match expected), or up to 75% of their FY13 award (with a 25% match expected),
whichever is applicable.
1. Describe additional financial resources and in-kind contributions secured to support sustainability efforts
and ensure that each site will continue to meet the requirements of the FC 245-A grant.
2. Complete the chart on the next page listing the grant funds and the other sources described in #1 above
that will be leveraged to support the specific line items. Please note if funds are dedicated to specific
sites.
9
Name of Grant Program: Massachusetts 21st Century Community Learning
Centers Program Continuation Grants
Fund Code: 647-A / 245-A
D. SUSTAINABILITY (FC 245-A) – (continued)
Funding Category
FY15
FC 245 Funds
Additional source(s)
and dollar amounts
that will be
leveraged
Total
Staffing (including, but not limited
to, instructional staff, planning
time, substitutes, etc.)
Professional Development
Contracted Providers/Vendors
Materials/Supplies
Transportation
Other: (please describe below)
Total Anticipated FY15 Costs
10