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)
Programs must offer a daily nutritious snack; breakfast (if applicable) and lunch
Yes
No
that meets the requirement of the United States Department of Agriculture
(USDA) National School Lunch Program. Confirm that these will be provided.
Please Note: Only complete the funding chart below if you are applying for two (2) sites. If applying for
one (1) site, only complete the funding chart under the site specific information on page 2.
Base amount of enhancement funds requested $
Up to $20,000/site
(If applicable) Additional Funding Opportunity - Total Requested $
(Up to $5,000/site for development of PBL or SL Curriculum;
or up to $2,000 ($500/staff) to pilot one of the SL Curriculum.
Total $
FY16 21st CCLC 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 current district vision and goals for summer programming and how it connects to and supports
the program described in this application.
2. Describe the planning process and the resources and/or expertise utilized. Address each of the following in
your response:

Identify the needs and priorities that this grant will impact (e.g., academic, social-emotional learning,
wellness, etc.). If applicable, include the reason(s) for prioritizing the chosen site(s) proposed to be
enhanced.

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.

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.
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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 Name:
Site Type
Site Coordinator:
Email
Address:
Please select from
the following
options
OST
ELT
Increasing the number of
students served by 25 percent
Adding Additional Time
Number of unduplicated students
served during the summer of 2015
Number of unduplicated students expected to
be served during the summer of 2016
Recipients of a FY16 FC 647-B1 Grant - Complete the Information Below
Total number of
Total number of
Total number of
Total number of
Percentage
hours originally
weeks originally
hours to be
weeks to be
increase of
planned for
planned for the
offered with
offered with
program hours
summer 2016
summer 2016
enhancement
enhancement in
funds in summer summer 2016
2016
Recipients of a FY16 FC 647-A or 647-B2 Grant - Complete the Information Below
Total number of
Total number of
Total number of
Total number of
Percentage
hours offered in
weeks offered in
hours to be
weeks to be
increase of
summer 2015
summer 2015
offered in
offered in summer
program hours
summer 2016
2016
from summer
2015 to 2016
(If applicable) Additional
Funding Opportunity
(place an X in the
appropriate box)
Project-Based Learning
Curriculum Development
Service-Learning
Curriculum
Development
Pilot
Service-Learning
Curriculum
Base amount of enhancement funds requested
Up to $20,000
(If applicable) Additional Funding Opportunity - Total Requested
(Up to $5,000/site for development of PBL or SL Curriculum;
or up to $2,000 ($500/staff) to pilot one of the SL Curriculum
Total amount of FY16 21st CCLC
grant funds to be used
$
Total value of in-kind services
$
Total of other funding sources (non 21st CCLC)
$
Total program cost (sum of 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. PROGRAM DEVELOPMENT AND IMPLEMENTATION (6 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. If applicable, describe the plan for adding the additional hours and the rationale for the selection.
c. 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
d. 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 average minimum of 80 percent of total attendance hours. Reminder:
students must enroll and participate for the entire length of the summer program. If you selected the
Increasing numbers of students served by 25 percent option provide the rationale for this selection.
e. Program Design:

Describe in detail how the program will build on the success of both the summer of 2015 (if applicable) and
the FY16 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.].

Use the “Planned Activities” chart found on page 5 to describe plans to provide innovative academic
enrichment (cohesive blending of academic learning and enrichment activities.
Additional Funding Opportunity #1 – Project Based Learning (PBL) Curriculum Development
Applicants ONLY
Applicants selecting this option will develop, pilot, and document PBL curricula that is project-based and supports
either ELA or mathematics.
 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.)
f.

Provide a timeline for curriculum planning and development. Please note that a minimum of 24 hours over
4 weeks should be dedicated to implementing the developed PBL curriculum.
g.
Additional Funding Opportunity #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.)

List the 3-5 team members who will attend or have attended 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.

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.) Please note that a minimum of 24
hours over 4 weeks should be dedicated to implementing the developed SL curriculum.

Provide a timeline for curriculum planning and development.
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Name of Grant Program: Massachusetts 21st Century Community Learning
Centers – Summer Enhancement Grant
Fund Code: 647-B4
Additional Funding Opportunity 3 – Pilot Service Learning (SL) Curriculum Applicants ONLY
Applicants selecting this option will implement and provide feedback on SL Curriculum developed as part of the
FY15 21st CCLC Summer Enhancement Grant and FY14 and FY15 After-School and Out-of School Time Quality
Enhancement Grant (ASOST-Q).
Staff who agree to pilot one of the SL curriculum will be required to participate in a training webinar on how to use
the curriculum, and also to provide feedback during and after implementation using a template that will be
provided. It is encouraged that staff piloting the SL curricula have participated in a 2-day or a 4-day SL training.
Please indicate how many staff plan to pilot each curriculum. (NOTE: Multiple staff people may pilot the same
curriculum, however each person is required to provide individual feedback.)
Curriculum Title
# of staff
# of these staff who have
who will
attended a 2-day or 4Click here for descriptions of the SL curriculum; including the
pilot
day SL training
estimated amount of time needed to implement*.
GenoExplorers
Healthy Food + Healthy Ecosystems = Healthy Communities
Healthy Harbors
Heat Islands
Human Use of Natural Resources
Hunger in Our Community
Kids Care: Cancer Misconceptions
Taking on Cyberbullying
Urban Adventures — Pollinators
Urban Adventures — Urban Waters
Watershed Ecosystem
Wetlands Stewardship at East Pond
Youth Ambassadors for Biodiversity
* If you would like additional information on any of the above curriculum please contact Kristen McKinnon
kmckinnon@doe.mass.edu or 781-338-6306. Selection is not binding; you may change your curriculum choice at
a later date.
If you have staff who have not yet attended a 2-day SL Planning and Implementation training, would they be
interested in attending one?
If Yes, please indicate how many staff would attend.
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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 learning, and build 21st Century skills. Please consider this when
formulating your response.
Note: Applicants choosing Option 2 – SL Curriculum Development or Option 3 – Pilot SL Curriculum do not need to include information about the SL
curriculum to be developed or piloted; 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 2016 (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
2. STAFF QUALIFICATIONS (1 page maximum)
a. Describe the staffing for the proposed program and services. Include the following:
 plans for quality personnel recruitment and retention;
 how the applicant will ensure that staff have the necessary qualifications to meet the diverse needs of the
target population;
 student: staff ratios; and
 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)
3. 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 selection of 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
4. 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.
5. 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. 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)
Mathematics
English/Language Arts
Intermediary Outcomes: During the summer months we will be asking enhancement sites to help pilot new
Social and Emotional Learning (SEL) intermediary outcomes.
b. Describe the process used in selecting the academic outcomes and how they support the district and school
curricular priorities, school improvement plans, and students’ needs.
6. TIMELINES (1 page maximum)
a. Include a brief timeline for continued program planning, program implementation and evaluation.
7. 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, 2016) and summer
budget (July 1- August 31, 2016), and a budget narrative for each that demonstrates clear and specific links to the
project activity plan. No more than 10 percent of the total budget may be used for materials and supplies. Please
note: Materials and supplies that will be purchased for summer programming should be included in the School
Year budget.
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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