Name of Grant Program: Academic Support Services Allocation Grant
Program
Fund Code: 632 (School Year)
625 (Summer)
PART III – REQUIRED PROGRAM INFORMATION
FY2012 Academic Support Allocation Grant Funds
THIS DOCUMENT MAY BE DOWNLOADED FROM THE DEPARTMENT OF
ELEMENTARY AND SECONDARY EDUCATION WEBSITE.
http://finance1.doe.mass.edu/grants/
Applicants wishing to run both School Year and Summer programs must submit separate applications (including
this Part III document) for each fund code. However, the answers will differ depending on whether you are
applying for a School Year versus Summer program.
I. GENERAL INFORMATION
1. District/approved private special education school/collaborative:
2. Program Coordinator name and title:
3. Mailing address:
4. Email address:
5. Phone #:
Fax #:
6. Indicate if the coordinator name/contact information is the same as FY2011:____ OR changed: ______
7. Program timeframe for this application (check one):
____School Year (9/1/11-6/30/12) OR _____Summer (7/1/12-8/31/12)
Program start date:_________ Fund Code: 632 (School Year) grants should be submitted a minimum of
15 business days prior to the proposed start of the program to allow sufficient time for review, resolution of
issues, and processing.
DUE DATE REMINDER:
*Fund Code 632 (School Year) applications by March 2, 2012 and Fund Code 625 (Summer) by April 6,
2012.
8a. Total (unduplicated) number of students to be served: ________
(Write the number projected to be served, not the total number eligible for services):
8b. Academic Support services will be provided in the following subjects (check all that apply):
English language arts ____
mathematics ____ science and technology/engineering ____
(Reminder: Students targeted to receive services in a subject area must be eligible for services in that
subject, based on the criteria outline in the RFP.)
8c. The following class years will be served through these Academic Support services (check all that apply):
_____ 2016/gr.8 _____ 2015/gr.9 _____ 2014/gr.10 _____ 2013/gr.11
_____ 2003-2011/post-12th(with no Competency Determination)
_____ 2012/gr.12
9. Total funds requested through this application: $
10. Provide a brief summary (one to two paragraphs) of the proposed program. This may be published
to www.doe.mass.ed/as along with the program contact information.
II. PROGRAMMATIC INFORMATION
1. Programmatic/Staffing Questions
a. What is the structure of the program? Check all that apply.
□ 1:1 Instruction
□ Work/Community Service Based Learning
□ 1:2-6 Small Group Instruction
□ Project/Theme/Multi-Disciplinary Based Learning
□ 1:10 Classroom Instruction
□ Web/Software Based Learning
□ Other (describe):
□ High School Transition Support
□ College/Career Readiness
b. What grade level(s) do you plan to serve through this Academic Support program?
c. Rationale for programming structure. Please include why this structure was chosen and the reasons
behind the grade levels, students, and subjects to be targeted with this fund use.
d. Data/information that addresses supports program rationale. What specific data (such as MCAS,
Early Warning Indicators, historical program data, etc.) were used when deciding on the structure of the
program.
e. Prior success. If applicable, please describe past success with the programming structure (note:
your description can be taken from your fiscal year 2011 program evaluation narrative if helpful).
f. Technical assistance and professional development (TA/PD). What type of technical assistance
and/or professional development do you anticipate to provide to staff, families, or partners involved with
the program? What kinds of TA/PD would you like the Department to consider offering?
2. Program Schedule –
Please fill in the charts below (A with School Year applications and B with Summer applications), illustrating the
proposed subject areas, schedule, timeframe, and class years to be served.
A. SCHOOL YEAR (FUND CODE: 632) - Only fill in this chart with School Year program applications.
Program Type
School Day Services
English Language
Arts
Time:____ to _____
Mathematics
Time:____ to _____
Science and
Tech./Engineering
Time:____ to _____
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr.
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr.
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr.
Total weeks: _______
Total hours: _______
Start date: _______
End date: _______
Total weeks: _______
Total hours: _______
Start date: _______
End date: _______
Total weeks: _______
Total hours: _______
Start date: _______
End date: _______
(Chart A continued on next page.)
Program Type
Extended School Day/Weekend/School Vacation Programs
English Language
Arts
Time:____ to _____
Mathematics
Time:____ to _____
Science and
Tech./Engineering
Time:____ to _____
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr. Sat.
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr. Sat.
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr. Sat.
Total weeks: _______
Total hours: _______
Start date: _______
End date: _______
Total weeks: _______
Total hours: _______
Start date: _______
End date: _______
Total weeks: _______
Total hours: _______
Start date: _______
End date: _______
B. SUMMER (FUND CODE: 625) – Only fill in this chart with Summer program applications.
Program Type
Summer Programs and
Services (Fund Code: 625 only)
English Language
Arts
Time:____ to _____
Mathematics
Time:____ to _____
Science and
Tech./Engineering
Time:____ to _____
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr. Sat.
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr. Sat.
Underline days
program meets.
Mon. Tues. Wed.
Th. Fr. Sat.
Total weeks: _______
Total hours: _______
Start date: _______
End date: _______
Total weeks: _______
Total hours: _______
Start date: ______
End date: ______
Total weeks: _______
Total hours: _______
Start date: _______
End date: _______
3. Indicate the number of staff and staff qualifications for each program.
NOTE: Recipients of these grants must agree to provide staff who have subject matter knowledge in the
subjects they are teaching. The programs must have some staff available with training or education that
addresses working with limited English proficient students or students with disabilities.
a. Number of Teachers by Content Area in the Program
Fill in the appropriate columns for the proposed School Year or Summer program.
i. English Language Arts (ELA)
School Year (for Fund Code: 632 applications)
English Language Arts (ELA)
Total number of English
instructors:
Number of licensed
English teachers:
Indicate the amount of
planning time per hour
of teaching:
List areas of licensure of
other teachers
instructing in ELA:
Type of staff utilized:
__School day full-time
__School day part-time
__Outside contractors
__Other (please specify):
Student to teacher ratio
(cannot exceed 10:1):
Summer (for Fund Code: 625 applications)
English Language Arts (ELA)
Total number of
English instructors:
Number of licensed
English teachers:
Indicate the amount
of planning time per
hour of teaching:
List areas of licensure of
other teachers instructing
in ELA:
Type of staff utilized:
__School day full-time
__School day part-time
__Outside contractors
__Other (please specify):
Student to teacher ratio
(cannot exceed 10:1):
ii. Mathematics
School Year (for Fund Code: 632 applications)
Mathematics
Total number of
mathematics
instructors:
Number of licensed
mathematics teachers:
Indicate the amount of
planning time per hour
of teaching:
List areas of licensure of
other teachers
instructing in
mathematics:
Type of staff utilized:
__School day full-time
__School day part-time
__Outside contractors
__Other (please specify):
Student to teacher ratio
(cannot exceed 10:1):
Summer (for Fund Code: 625 applications)
Mathematics
Total number of
mathematics
instructors:
Number of licensed
mathematics teachers:
Indicate the amount of
planning time per hour
of teaching:
List areas of licensure of
other teachers instructing
in mathematics:
Type of staff utilized:
__School day full-time
__School day part-time
__Outside contractors
__Other (please specify):
Student to teacher ratio
(cannot exceed 10:1):
iii. Science and Technology/Engineering
School Year (for Fund Code: 632 applications)
Science and Technology/Engineering
Summer (for Fund Code: 625 applications)
Science and Technology/Engineering
Total number of
science and tech/eng.
Instructors:
List areas of licensure of
other teachers
instructing in science
and tech/eng.:
Total number of
science and tech/eng.
instructors:
List areas of licensure of
other teachers instructing
in science and tech/eng.:
Number of licensed
science and tech/eng.
teachers:
Type of staff utilized:
__School day full-time
__School day part-time
__Outside contractors
__Other (please specify):
Number of licensed
science and
tech/eng.teachers:
Type of staff utilized:
__School day full-time
__School day part-time
__Outside contractors
__Other (please specify):
Student to teacher ratio
(cannot exceed 10:1):
Indicate the amount
of planning time per
hour of teaching:
Student to teacher ratio
(cannot exceed 10:1):
Indicate the amount of
planning time per hour
of teaching:
iv.
Indicate the qualifications of those responsible for direct services not listed above.
____Check if not applicable.
__________________________________________________________________________________________
III. STUDENT SUPPORT COORDINATION AND COLLABORATION
NOTE: This section III is REQUIRED for programs applying for at least $25,000; it is optional for others.
One of the major goals of the Department's programs is to promote the coordination of resources that help
communities assist students who are confronted with barriers to learning, including both prevention and intervention
efforts. These include ways to:

establish a continuum of approaches that are comprehensive, multifaceted, cohesive, and strive to promote
healthy development and prevent barriers to learning;

provide early interventions that are effective and efficient; and

assist with chronic and acute barriers to learning in a persistent and positive way.
1. COORDINATION AND COLLABORATION OF STUDENT SUPPORT PROGRAMMING
a. Note which of the following resources the proposed program will coordinate with, in order to
maximize efforts to address barriers to learning for students. Please note that only Learning
Support and Collage & Career Readiness grant programs are listed here, but there is space to list other
related resources with which you are coordinating (e.g., McKinney Vento Homeless Education, etc.).
Check all that apply:
___ Academic Support Competitive Grant Programs
___ After-School and Out-of-School Time (ASOST) - state funded
___ Dropout Prevention and Recovery Planning and Programming
___ High School Graduation Initiative (MassGrad)
___ Online Learning for At-Risk Students
___ Service Learning
___ 21st Century Community Learning Centers (CCLC) – federally funded
___ Other (public or private) Please list__________________________________________________
b. Strategies for working with others towards student success
Describe how staff and partners (internal and external) will work with others in your district/community
regarding student recruitment, directing students to the most appropriate local resource(s), sharing
information related to program design and assessment, opportunities for professional development,
implementing successful strategies for all or specific students, etc. Describe specific assets each partner
brings to the program and the specific needs they are able to address.
c. Communication among stakeholders
Describe specific actions/activities that you will take to effectively communicate with different local
stakeholders about your student support grant program(s)/services and participants. In preparing your
answer, consider how you will be able to assess whether sufficient communication is happening (and how
to improve it if needed) across stakeholders regarding the types of programs and supports that are available,
strategies that are effective, and student-specific information that is both helpful and appropriate to share.
IV.
ADDITIONAL REQUIREMENTS
1. Assurance Document – must be completed if applicant will be serving students in the classes of 2014-2016.
2. Grantees must use the Evaluation Guidelines to prepare a narrative report on the overall effectiveness of the
program. Reports are due July 31, 2012 for School Year programs and September 28, 2012 for Summer
programs.
3. Individual Student Data information must be compiled and submitted to the Department via the online
application in the security portal. The Department will provide further details upon grant approval. Information
will be posted to http://www.doe.mass.edu/as/data/. Individual student data for fiscal year 2012 will be similar
to the information submitted regarding the fiscal year 2011 programs. Dates due are the same as for the
Narrative Evaluations (see Additional Information section of RFP).
4. More information can be found in the Guidance Documents in the Additional Information section of the RFP.