Name of Grant Program:
Massachusetts 21st Century Community Learning Centers
– Supporting Additional Learning Time (ELT and OST)
Fund Code: 647-B1
PART III-b – REQUIRED PROGRAM INFORMATION – FY16
School/Site Implementation Plan
Descriptions and Key Components of
Grant-Allowable Models for Adding Time through Fund Code 647-B1
Please see the Funding Opportunity-Request for Proposals (FO-RFP) for additional information including:
minimum eligibility requirements, maximum funding request amounts and priorities for the use of grant funds.
Model 1 (ELT)
Maximum number of
school(s)/site(s)* for which an
applicant may apply:
Model 2 (OST)
Districts/communities with:
 >50% Low-Income, and
 > 10,000 students
Two schools/sites
No maximum
(Using 2014 low-income
and enrollment status.)
All other districts/communities:
One school/site
*All schools/sites must meet the criteria outlined in the Eligibility section of the FO-RFP.
Model 1: Expanded Learning Time (ELT)
For all students: Applicants will establish a school schedule that increases the total number of hours required for
all students by a minimum of 180 hours above the amount offered in either fiscal year (FY)14 or FY15, and
reflects a total of a minimum of 1,330 hours.

Grant funds must be used primarily to support the implementation of new or enhanced academic
enrichment and/or intervention opportunities.

Other costs associated with adding time should be carefully considered and applicants must describe a
plan for covering these costs.

All students are required to participate in ELT; however, it is not expected that the grant funds cover
activities that benefit all children.
Model 2: Out-of-School Time (OST)
For targeted students: Applicants choosing this option will offer a total of a minimum of 448 hours of
comprehensive OST programming during the school-year and summer for a targeted group of students.

Comprehensive OST programming typically consists of time for: informal/social time, homework/academic
support, club or activity time (offering inquiry-based, service-learning and other project-based learning
opportunities), social-emotional programming, etc.

Enrolled students are not expected to attend all 448 hours, however it is expected that students will
attend the OST programming an average of a minimum of 80 hours for high school (grades 9-12), 90 for
middle school (grades 6-8) and 100 hours per school year for elementary schools (K-5).
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Massachusetts 21st Century Community Learning Centers
– Supporting Additional Learning Time (ELT and OST)
Name of Grant Program:
I.
Fund Code: 647-B1
SCHOOL/SITE IMPLEMENTATION PLAN
IMPORTANT NOTE:
Applicants should submit ONE proposal with a separate School/Site Implementation Plan (Part III-b) for each
school/site included. Information about the limits on the number of schools/sites for which an applicant may apply
can be found in the FO-RFP.
School/Site Name:
School/Site Contact Name:
Phone:
Email:
Model Chosen (Place an “x” in the box that applies.)
Model 1 – ELT
Competitive
Priority:
(Place an ‘x’ in
the box for each
that applies.)
Model 2 – OST
Proposing to implement more time in a school designated as Level 3, 4, or 5
under Massachusetts' district and school accountability and assistance system
Proposing to serve youth in schools/communities
Please indicate the
with higher percentages of students with lowschool’s* low-income %
income for 2014, as indicated at the Department's
below:
School and District profiles page
(http://profiles.doe.mass.edu/).
Submitting this application in full partnership that includes a school district, and a
community-based organization(s) or other public or private entity(ies). Please list
those entities below:
The following competitive priorities apply to Model 1 (ELT) Applicants Only
Proposing to add time at a middle school.
Propose to implement a blended learning educational model.
Reviewers will look for evidence of meeting this competitive priority in the
response to Question 7.
Propose to implement an expanded school calendar.
Reviewers will look for evidence of meeting this competitive priority in the
responses to Questions 17 and 18.
Propose to implement a teacher career ladder model.
Reviewers will look for evidence of meeting this competitive priority in the
response to Question 8.
*If the site is not a public school, please use the low-income % of the school in which the majority of students
served are enrolled. If students served are from multiple schools, please use the district’s low-income %.
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Name of Grant Program:
Massachusetts 21st Century Community Learning Centers
– Supporting Additional Learning Time (ELT and OST)
Fund Code: 647-B1
Instructions for completing this document:

Please address each of the applicable questions on the following pages within the indicated page limits.

Questions are labeled as follows to indicate which applicants should respond, according to the model
chosen for the respective site:
o [ALL] – Schools/sites applying for Model 1 (ELT) AND Model 2 (OST) should respond.
o [Model 1 (ELT) ONLY] – Only schools applying for Model 1 (ELT) should respond.
o [Model 2 (OST) ONLY] – Only schools/sites applying for Model 2 (OST) should respond.

Responses should be provided within this document leaving the questions above each response.

Please do not delete questions that are not applicable – this will re-number questions and may lead to
confusion in responding to questions that reference earlier questions.

Please do not change the font size or margins.

All questions are shaded in gray and responses should be written in the white space below each
question. This is designed to make it easier to see the questions versus the responses.

Narrative and/or bulleted responses are acceptable.
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Name of Grant Program:
Massachusetts 21st Century Community Learning Centers
– Supporting Additional Learning Time (ELT and OST)
Fund Code: 647-B1
Process and Rationale for Additional Time: (3 pages maximum)
1. [ALL] Describe the school’s/site’s process for planning for additional time and for developing this proposal.
Include a list of the members of the team that developed the proposal and their respective roles. Describe the
process for gathering input and “buy-in” from key stakeholders (including teachers/staff, parents, students and
community partners).
2. [ALL] Describe the school’s/site’s plans and structures for overseeing, monitoring and evaluating the
implementation of additional time. Include a description of the implementation team and their respective
roles. If applicable, describe the qualifications/credentials the program will seek for a site-coordinator; or, if
that role already exists, provide the current site-coordinator’s qualifications/credentials. If the required district
coordinator, described in Question 4 of the District Summary (Part III-a), will assume this role, please indicate
as such.
Proposed Typical Day (1 page maximum)
3. [ALL] Provide a narrative describing what a typical day will look like at the proposed school/site. This
summary should give grant reviewers an idea of how students will experience the newly added time. The
response to this question should be in the form of a story that describes a student’s experience in the
program. This narrative “story” should include: an overview of the schedule, examples of activities offered,
highlights of expected peer/peer and adult/student interactions; other highlights resulting from grant-funded
activities. The specifics of program scheduling and implementation are requested in the following questions.
Implementing Additional Time (15 pages maximum for Questions 4-16, including Question 7 chart(s)):
4. [ALL] Describe the specific targeted population to be served through grant-funded programming/activities.
[Model 1 (ELT) applicants should only respond if grant-funded activities will not benefit ALL
students.]
4a. [Model 1 (ELT) ONLY] If the school houses specialized programming for special populations of students
(e.g. students with disabilities, English Language Learners, etc.), please describe how the school and district
will ensure that needs of these students resulting from additional time will be met, including financial and
programmatic considerations.
5. [Model 2 (OST) ONLY] Describe planned outreach strategies to recruit and retain the students targeted for
participation in the proposed OST program.
6. [ALL] Briefly describe the school’s/site’s specific needs and priorities related to students’ academic,
social/emotional, civic engagement, wellness, etc. that will be addressed through engaging instructional
practices and academic enrichment opportunities. Include relevant data that supports the need in the
identified areas.
6a. [ALL] – Funded applicants are required to use the Department-provided Survey of Academic Youth
Outcomes (SAYO) and Assessment of Program Practices (APT) tools to assess the impact of 21 st CCLC
programming. Please refer to Addendum E – SAYO Outcomes Selection and APT Information for more details.
[Model 2 (OST) Only] – Please complete Addendum E to indicate the outcome areas, aligned to the
needs/priorities above, that this site will measure.
Note for Model 1 (ELT) – Funded ELT sites will measure the Engagement, Initiative and Relationships outcomes
areas, as these were identified by the tools’ creators as those most applicable to ELT.
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Name of Grant Program:
Massachusetts 21st Century Community Learning Centers
– Supporting Additional Learning Time (ELT and OST)
Fund Code: 647-B1
7. [ALL] Using the chart that follows, briefly describe the engaging instructional practices and enrichment
opportunities that will be implemented to address the identified needs/priorities described in the previous
question. Responses may include a description of teaching/learning strategies that will be implemented by
educators as well as examples of enrichments/clubs that will be offered.
Reminder: Grant-supported activities should align to the school’s described needs/priorities, but also to the grant
priorities. Please see the Priorities section in the posted FO-RFP document.
Applicants are required to implement service-learning or other project-based learning strategies. A plan for doing
so should be included in the chart.
INSTRUCTIONS for completing the chart:
 In the “Proposed Activities” column, include up to 1-2 paragraph descriptions for each proposed activity.
(See examples provided as guide for what to include.)
 In the “Needs/Priorities…” column, include 5-10 words describing how the activity supports one or more
of the needs/priorities identified in Question 6 above, as well as the chosen SAYO outcomes.
 In the “New?...” column, indicate whether the activity is either: New, Enhanced, or Ongoing
 In the “Funding?...” column, indicate either: Fully, Partially, or Not (to indicate the extent to which the
activity is funded by this grant request). For those activities that are “Partially” or “Not” funded through
this grant, provide a brief description of how they will be supported.
 Add additional rows as needed. (Select an entire blank row, right click, select “Insert Row Above” or
“Insert Row Below”)
 Cells will automatically expand (down) to fit what is typed. Please do not change the column widths.
Proposed Activities
Needs/Priorities/
SAYO Outcomes
Addressed
New?
Enhanced?
Ongoing?
Funding?
(Fully, Partially or
Not)
EXAMPLE 1: All enrichment providers, including school
staff and partners, will be trained in project-based learning
(PBL) and are expected to incorporate this teaching and
learning approach, as appropriate, into their offerings.
ELA, higherorder thinking
New
Partially. Additional
local PD funds will be
used to include
providers in trainings
on PBL.
EXAMPLE 2: STEM is Awesome. Middle and elementary
students will participate in this enrichment, offered 2
days/week for each grade-level. Students and staff will use
inquiry to tackle daily questions that prompt them to
explore, watch, wonder and work together to respond to
their environment. Students will engage in hands-on
activities, have take-home projects to work on with their
families at home, and have opportunities to write about and
reflect on their learning.
Multidisciplinary,
mathematics,
hands-on
New
Fully
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Name of Grant Program:
Massachusetts 21st Century Community Learning Centers
– Supporting Additional Learning Time (ELT and OST)
Fund Code: 647-B1
8. [Model 1 (ELT) ONLY] Briefly describe the school’s plan for staffing ELT. Include information about
changes to teachers’ scheduled hours and workload, as well as how additional hours will be compensated.
Also include information about how qualified partners, vendors and volunteers will be involved in staffing an
expanded day. Note: If applicable, include planned or secured changes to collective bargaining agreements.
9. [Model 2 (OST) ONLY] Describe the qualifications/credentials the program will seek for program staff to
meet the needs of the targeted population, including students on IEPs and English Language Learners.
9b. [Model 2 (OST) ONLY] Describe plans for recruiting and retaining qualified staff.
9c. [Model 2 (OST) ONLY] Describe plans for providing CPR and first aid training to program staff, within at
least two months of employment. (Federal requirement)
10. [ALL] Describe the structure and opportunities for professional development and collaboration that will
support educators in the implementation of proposed activities, as well as continuous program improvement.
Describe plans for including partners, contracted providers and volunteers in these opportunities.
Note: The Massachusetts 21st CCLC program offers a variety of professional development opportunities to
support program implementation, many of which are optional and designed to support programs’ PD needs and
continuous program improvement. Please see Addendum A - Grant Assurances for details on grant PD
requirements.
11. [ALL] Describe plans for building and strengthening partnerships among schools/sites, families and
communities in order to advance common goals for student success. Note: Only include here school-level
partnerships that were not already described in Part III-a (District), Question 6).
12. [ALL] If the program plans to contract with any outside vendors/community based agencies, describe the
criteria used for selecting contracted providers and how the services they will provide connect to and support
identified needs and intended outcomes.
13. [ALL] In which of the following areas will the applicant set aside the required five (5) percent of the total grant
request. NOTE: The five percent set-aside is required of the total grant, not per site; however activities in one
or both areas must be targeted to each site. (Place an “x” in one or both of the boxes below)
Family Involvement. This may include a part-time Family Engagement/Outreach Liaison if one does not
currently exist.
Social/Emotional Learning and Supports. This may include contracting with partners to provide social
work or mental health services, etc.
Describe how this school/site will use its portion of this five percent set-aside, including the rationale for the
selection and the types of services/supports that will be provided.
14. [ALL] Describe how the program will ensure that students travel safely to and from the program.
Note for Model 1 (ELT) Applicants: Federal regulations require that all 21st CCLC grantees describe a plan for
transportation of students. Please describe how students travel to and from school and highlight any proposed
changes as a result of ELT.
15. [Model 2 (OST) Only] Provide a brief (1 paragraph or up to five (5) bullets) description of the current plans for
offering a required summer program. Note: Funded applicants will submit a summer program plan in
February 2016.
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Name of Grant Program:
Massachusetts 21st Century Community Learning Centers
– Supporting Additional Learning Time (ELT and OST)
Fund Code: 647-B1
16. [Model 2 (OST) Only] Describe the location and space in which the OST program will take place. Describe
how the program will ensure a welcoming environment with necessary resources to implement activities,
stimulate learning, and provide space to exhibit students' work and projects. Please refer to the Addendum A
- Grant Assurances document in the FO-RFP Required Forms section regarding space requirements.
17. [Model 1 (ELT) ONLY] Use the chart below to provide information about the school hours/days required for
all students. (1 page maximum)
Note: The school must add a minimum of a total of 180 hours to the school year (required for all students) above
what was offered in school year 2014-2015 (SY15), and offer a schedule that reflects a minimum of 1,330 hours.
If the school newly implemented expanded learning time during SY15, the proposed schedule for the 2015-2016
school year must reflect a minimum of 180 hours above what was offered in 2013-2014 (SY14), and reflect a
minimum of 1,330 hours. In this case, the school should provide the schedule from SY14 as the “Pre-ELT”
schedule.
SAMPLE YEAR
Date school
began:
9/2/2014
Date school ends:
6/19/2015
Start/End Time
8:15 – 2:15
8:15 – 12:15 (early release days)
Hours
# of days Total Hours
6
170
1020
4
10
40
TOTALS 180
1080
Pre-ELT SY15 (2014-2015) (or 2013-2014 if ELT was newly implemented in 2014-2015)
Date school began:
Date school ended:
Enrollment
Grades Served:
School Start/End Time [insert rows if needed]
Hours
# of days Total Hours
TOTALS
PROJECTED ELT SY16 (2015-2016)
Date school begins:
Date school ends:
Anticipated
Anticipated Grades
Enrollment:
Served:
School Start/End Time [insert rows if needed]
Hours
# of days
Total Hours
TOTALS
18. [Model 1 (ELT) ONLY] Provide the following schedules (inserted into this document – 5 pages
maximum):
a. Pre-ELT (SY15) Student Schedule (or, provide SY14 if ELT was newly implemented in SY15)
b. Pre-ELT (SY15) Teacher Schedule (or, provide SY14 if ELT was newly implemented in SY15)
c.
Proposed (SY16) Student Schedule
d. Proposed (SY16) Teacher Schedule
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Name of Grant Program:
Massachusetts 21st Century Community Learning Centers
– Supporting Additional Learning Time (ELT and OST)
Fund Code: 647-B1
19. [Model 2 (OST) ONLY] Use the chart below to provide the anticipated OST program schedule. (1 page
maximum, Questions 19-20)
Applicants are free to propose any schedule configuration that meets the following requirements:
 Operate for 448 hours total (school year and summer)
 Operate a minimum of 8 hours per week during school year programming
 Funds cannot be used to support only before school and/or summer programs.
 If proposed, before-school services must run for at least one (1) hour each morning offered, and conclude
before the school day begins.
Two sample schedules are provided below for reference.
It is not expected that all students will attend all 448 hours; however students are expected to participate, at
minimum, for the following number of hours, on average:
Elementary School – 100 hours
Middle School – 90 hours
High School – 80 hours
Drop-in programs are not allowed.
SAMPLE SCHEDULES (for reference only – not required)
School Year
Summer
384 Hours (12 hrs./wk. x 32 wks)
64 Hours [16 hrs./wk. (4 hrs./day for 4 days/wk.) x 4 wks.]
Includes before school
256 Hours (8 hrs./wk. x 32 wks.)
192 Hours [24 hrs./wk. (6 hrs./day x 4 days) x 8 wks.]
Anticipated
# Youth to
be Served
#
Hours
/ week
#
Weeks
Total
#
Hours
Days of
Week
(e.g., M-F)
Total
448
448
Program Times
School Year
(before
school)
Start Time:
School Year
(after
school)
Start Time:
End Time:
End Time:
Start Time:
Summer
End Time:
Total # of Hours Offered:
Must be a minimum of 448.
20. [Model 2 (OST) Only] To as ensure that students are meeting the required hours noted on page 1 and
above, describe the student attendance policies for both the proposed 21st CCLC OST and the summer
program, including how often students will be required to attend.
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