Name of Grant Program:
After-School and Out-of-School Time Quality Grant
Fund Code: 530
PART III – REQUIRED PROGRAM INFORMATION
FISCAL YEAR 2012 PROGRAM SUMMARY COVER SHEET
Total Amount of Grant
Funds Requested:
Total Amount of Match Proposed:
$
$
(must be at least 20% of Grant Request)
Applicant Agency:
Program Coordinator
Name/Title:
Address:
Phone:
Email:
ASOST PROGRAM ENROLLMENT
Total number of children/youth enrolled in existing ASOST programs
(FY2011):
School
Year
Summer
Proposed number of children/youth to be served by or who will benefit
from proposed grant activities (FY2012):
Grade Level(s)to be served: (check all that apply)
K-5
6-8
9-12
Targeted Population(s): For each category below, indicate the approximate number of students in each category who will be
served by or who will benefit from proposed grant activities.
Low-Income #:
Students with IEPs #:
English Language Learners #:
Total number of sites where proposed ASOST Quality Grant activities will take place:
SITE(S) WHERE PROGRAM ACTIVITIES WILL TAKE PLACE (Please add additional rows if necessary. To
do so, select one of the rows below so that the entire row is highlighted, right click your mouse and click “insert rows”)
Site Name:
Address:
City/Town:
Provide a brief summary of the proposed ASOST quality grant activities (50 words or less):
Name of Grant Program:
After-School and Out-of-School Time Quality Grant
Fund Code: 530
Responses to the Program Characteristics section below must be completed within this
document, and cannot exceed 12 pages and must maintain the existing margins, question text,
and font style and size.
PROGRAM CHARACTERISTICS
Please answer the following questions about current programming provided through your program(s)
and/or your partners program(s).
1. Licensing: Which of the following applies to your program (lead agency) with respect to licensing?
EEC Licensed
License Exempt
Public School Operated
Other Community Based Organization
2. Program Fees: Does your program charge tuition for participation in program activities?*
No
Yes – IF YES, how much do you charge?
Do you accept EEC vouchers?
Do you have a sliding scale for families who may not be able to afford tuition?
*Please note that funded programs are required to ensure that scholarships, sliding scale fees, or other
resources are available for families who may not be able to afford tuition.
3. Program Description:
Please provide a one-paragraph description of existing ASOST program services offered by both the
lead applicant and partnering agencies. In addition, please provide a one-paragraph description of
the quality enhancements proposed through these grant activities. This description may be used to
summarize program activities on the Department’s ASOST webpage.
4. PROGRAM SCHEDULE – Please fill in this schedule with information about the proposed activities.
Site:
Site:
Site:
School Year Program
Time:
to
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr. Sat.
Total weeks:
Start date:
End date:
Anticipated Number
of Students:
Time:
to
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr. Sat.
Total weeks:
Start date:
End date:
Anticipated Number
of Students:
Time:
to
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr. Sat.
Total weeks:
Start date:
End date:
Anticipated Number
of Students:
Summer Program
Time:
to
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr. Sat.
Total weeks:
Start date:
End date:
Anticipated Number
of Students:
Time:
to
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr. Sat.
Total weeks:
Start date:
End date:
Anticipated Number
of Students:
Time:
to
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr. Sat.
Total weeks:
Start date:
End date:
Anticipated Number
of Students:
Name of Grant Program:
After-School and Out-of-School Time Quality Grant
Fund Code: 530
5. Quality Enhancements: Please describe the proposed quality enhancements to be implemented
through this grant program. For each applicable enhancement, please provide a brief description for
the need for undertaking the described activities. Note: All applicants must address
enhancements in both the Partnerships (II) and Evaluation Systems (VI) criteria listed below.
Additional information about each of these guidelines can be found in the Guidelines for Quality
Enhancements in After-School and Out-of-School Time Programming found in the Additional
Information section of the RFP.
I.
Comprehensive Academic and Non-Academic Programming: Describe plans to support and
enhance a balance of academic and non-academic services, with a focus on one or more of
the Massachusetts Curriculum Frameworks.
a. Activities Proposed:
b. Need for these enhancements:
II. Partnerships: [REQUIRED FOR ALL APPLICANTS] Describe plans to work collaboratively to
build on community strengths to deliver effective services that provide continuity for students
between the school-day and after-school programs. Include coordination with other
community-based organization partners, if applicable.
a. Activities Proposed:
b. Need for these enhancements:
III. Serving Special Populations: Describe plans to enhance services and supports for students with
Individualized Education Programs (IEPs) and/or English language learners so that they may
participate in after-school and out-of-school time programs and activities with their same-aged
peers who do not have IEPs or who are proficient English speakers, respectively.
a. Activities Proposed:
b. Need for these enhancements:
IV. Family Involvement: Describe plans to provide many and varied opportunities for families to be
engaged in their child’s after-school program.
a. Activities Proposed:
b. Need for these enhancements:
V. Highly Qualified Staff: Describe professional development plans that address topics and issues
related to strengthening the quality of after-school and out-of-school time programs, including
but not limited to training on the Department's Curriculum Frameworks, leadership and
partnership development, social-emotional learning, and working with a diverse student
populations.
a. Activities Proposed:
b. Need for these enhancements:
Name of Grant Program:
After-School and Out-of-School Time Quality Grant
Fund Code: 530
VI. Evaluation Systems [REQUIRED FOR ALL APPLICANTS] Describe plans to design and
implement a comprehensive evaluation system that assesses the effect of all programs and
services.
a. Activities Proposed:
b. Need for these enhancements:
6. Addressing Barriers to Participation: If applicable, describe grant activities that are aimed at
reducing barriers to participation.
7. Program Goal(s): Describe briefly the goal(s) of the ASOST programs and services to be provided
through this grant.
8. Measurable Outcomes/Objectives: Describe briefly the program outcomes/objectives that the
proposed activities and services aim to achieve. The outcomes described should be the result of the
work—its impact on children/youth, staff and others that you serve—not the activities that will be
implemented. (For example: By June 2012, 80% of 8th grade youth participating in the ASOST
program will report that they have learned specific math skills that have helped them in school.) Note:
Applicants must propose at least one outcome related to the youth being served. Add
additional lines as needed.
Outcome/Objective
Baseline data
(if applicable)
How will this be
measured? What
tools will be used?
Who will be
responsible?
9. Funding to Support ASOST Programming: Please complete the chart below describing all funds
that support the ASOST programming provided by the lead applicant and partners. Please indicate
the amount of funding, and in the “Detail” column list the sources.
Funding Category
Federal (include 21st CCLC here)
State
Local
Private (include foundation grants, private
donations, etc.)
Tuition
Other
Total Amount
Detail
Name of Grant Program:
After-School and Out-of-School Time Quality Grant
Fund Code: 530
(FOR APPLICANTS THAT ARE AGENCIES OTHER THAN A PUBLIC SCHOOL/DISTRICT, CITY, OR
TOWN ONLY)
*Note: This page will not be counted in the 12-page limit and should only contain the response to part a.
below. The response should not exceed one page maintaining the existing margins question text, and
font style and size.
10. Program Capacity: Applicants that are from agencies and organizations other than a school, school
district, city, or town must provide the following additional information.
a. Describe your previous experience with similar amounts of funding at state, federal, or
local levels through government, foundation, or private grants.
b. Append to this application proof of fiscal responsibility, for example, a copy of the most
recent annual audit letter (the entire audit need not be attached.)