Name of Grant Program: Title II-B: Massachusetts Mathematics and Science Partnership Program (MMSP) Fund Code: 150-A PART III – REQUIRED PROGRAM INFORMATION AND APPLICATION General Program Requirements Proposed MMSP partnership activities must address previously planned supplemental, follow-up, or evaluation activities to complete the partnerships MMSP grant work. These activities should support the implementation of previous MMSP course content into standards-based instruction and facilitate connections between the course(s) and district/school STEM initiatives. Supplemental, follow-up and evaluation activities proposed should specifically integrate the professional development with the needs and STEM improvement initiatives of the partnering school district(s). These MMSP partnership activities may include: 1. creating or updating district/school STEM alignment documents and or instructional materials, especially to support implementation of the 2011 Mathematics Curriculum Framework; 2. supporting STEM school improvement plans; 3. developing tools to assess teachers' STEM professional development needs to inform their individual professional development plans; and/or 4. providing instructional leadership training and protocols to facilitate effective site-based supplemental activities and standards-based instruction incorporating mathematics and science standards and practices. A. Applicant (Organization) and Partners: B. Project Title and Updated Abstract: C. Project Impact: Grant Close out Activities Year 4 Number of Districts List of Districts: put an * by those that are high need Funding Request List Supplemental / Followup/Evaluation Activities * D. Contact Information* (only note any changes from prior year) Name Affiliation Telephone Number Email Address Project Director Partnership Coordinator Partnering District/IHE Contact Fiscal Contact Evaluator *Please be sure that each partner has at least one key contact listed; add additional rows as needed. 1 Name of Grant Program: Title II-B: Massachusetts Mathematics and Science Partnership Program (MMSP) Fund Code: 150-A PART III – REQUIRED PROGRAM INFORMATION AND APPLICATION E. Description of Activities For supplemental, follow-up, and evaluation activities, please provide: 1. Summary of the STEM initiatives in the partnering district(s) and an explanation of how the proposed activities align and complement the work (i.e. learning community work on incorporating the Standards for Mathematical Practice into lessons, curriculum mapping, alignment, and unit planning, development of STEM instructional leaders, etc.) 2. Brief description of each activity including number of hours (contact, online, etc.) 3. Facilitators/Instructors, and 4. How these activities will help teachers implement content from the course of study into their classrooms to improve student learning. STEM initiative Activity Total Hours ** Activity Facilitator/Instructor Alignment Description 1. 2. 3. 4. 5. TOTAL HOURS: ***List actual contact hours; indicate required online hours in parentheses, where applicable. H. End of Grant Data Briefly summarize the projected outcomes, evaluation measures, how the data will be collected, by whom, and how, when, and whom will report this data to DESE. If the data collected will impact the Annual Performance Report (APR) for the partnership indicate who will complete the FY15 APR report. I. Project Timeline Include a monthly timeline for implementation of this year‘s activities, including course end dates, leadership meetings, planning/designing meetings, data review meetings, and follow-up activities. Timeline for Implementation FY15 November Activities December Activities January Activities 2 Name of Grant Program: Title II-B: Massachusetts Mathematics and Science Partnership Program (MMSP) Fund Code: 150-A PART III – REQUIRED PROGRAM INFORMATION AND APPLICATION February Activities March Activities April Activities J. Budget Breakdown In the table below, include only expenditures for this fiscal year (Award to August 31, 2015). Proposals for FY2015 may include a provision for local evaluation of the partnership activities if the partnership intends to submit the FY15 APR. The budget items, entered in the tables below, should be tied clearly to the scope and requirements of the project. The budget information should identify the items used in determining the amounts shown on the separate Budget Expenditures form (Required Program Information: Part II – Project Expenditures). Partnership Staff Budget Information For partnership staff expenditures, include: name; institution; primary type of activity (such as program coordination, planning, instruction, evaluation, onsite support of teachers in their classroom, travel, etc.) rate per hour or day; and number of hours/day, where applicable. Use multiple lines for the same person if different rates apply for different activities. Insert rows as needed. Name of Partnership Staff and Institution Type of Activity Rate per Hour/Day Number of Days Number of Hours Total Total Staff Expenditures 3 Name of Grant Program: Title II-B: Massachusetts Mathematics and Science Partnership Program (MMSP) Fund Code: 150-A PART III – REQUIRED PROGRAM INFORMATION AND APPLICATION Materials, Supplies, Incentives, Indirect and Other Costs Specify the materials, supplies, and incentives (stipends, graduate credits, MTEL, or substitutes) reported in the Budget Details form. Include the cost per unit and number of units. Add Indirect costs in this table. Insert rows as needed. Activity Material, Supply, or Incentive Cost per Unit Number of Units Total 1. 2. 3. 4. 5. Total materials, Supplies Incentives and Indirect Costs 4