Name of Grant Program: Academic Support Services Allocation Grant
Program
Fund Code: 632 (School Year)
625 (Summer)
PART III – REQUIRED PROGRAM INFORMATION
FY2013 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 FY2012:____ OR changed: ______
7. Program timeframe for this application (check one):
____School Year (9/1/12-6/30/13) OR _____Summer (7/1/13-8/31/13)
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 1, 2013 and Fund Code
625 (Summer) by April 5, 2013.
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 Funding Opportunity (RFP) document.
8c. The following class years/grades (as of 9/1/2012) will be served through these Academic Support
services (check all that apply):
_____ 2017/gr.8 _____ 2016/gr.9 _____ 2015/gr.10 _____ 2014/gr.11
_____ 2003-2012/post-12th (with no Competency Determination)
_____ 2013/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.
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Name of Grant Program: Academic Support Services Allocation Grant
Program
II.
Fund Code: 632 (School Year)
625 (Summer)
PROGRAMMATIC INFORMATION
(Note: Questions with an asterisk (*) are those requesting information most closely related to the Department’s
District Standards and Indicators and the Department Priorities for increasing student performance.)
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. 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.
c. 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.
d. Prior success. If applicable, please describe past success with the programming structure (note:
your description can be taken from your fiscal year 2012 program evaluation narrative if helpful).
e. 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?
f. District Standards/Indicators and Strategies.* Please indicate (with an ‘x’ or a check mark) which of
the following select Standards’ Indicators and Department Priorities will be deliberately and intentionally
supported through the activities proposed in this grant application:*
SELECT DISTRICT STANDARDS AND INDICATORS:
Curriculum and Instruction
Aligned, consistently delivered, and continuously improving curriculum
Sufficient instructional time
Assessment
Data collection and dissemination
Data-based decision-making
Student assessment
Human Resources and Professional Development
Professional development
Student Support
Academic support
Access and equity
Educational continuity and student participation
Services and partnerships to support learning
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Name of Grant Program: Academic Support Services Allocation Grant
Program
Fund Code: 632 (School Year)
625 (Summer)
Programmatic/Staffing Questions (continued)
DEPARTMENT PRIORITIES:





Prepare students for college and careers
Strengthen curriculum and instruction
Improve educator effectiveness
Use data effectively to support student achievement
Turn around our lowest performing schools
OPTIONAL: Please comment on the above table if there is more detail you want to add beyond what is
already described in other responses in the application.
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 these charts with School Year program applications.
Program Type
School Day Services
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.
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: _______
English Language
Arts
Mathematics
Science and
Tech./Engineering
Time:____ to _____
Time:____ to _____
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: _______
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Name of Grant Program: Academic Support Services Allocation Grant
Program
Fund Code: 632 (School Year)
625 (Summer)
b. SUMMER (FUND CODE: 625) – Only fill in these charts with Summer program applications.
English Language
Arts
Program Type
Summer Programs and
Services (Fund Code: 625 only)
Time:____ to _____
Mathematics
Science and
Tech./Engineering
Time:____ to _____
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)
Summer (for Fund Code: 625 applications)
English Language Arts (ELA)
Total number of English
instructors:
List areas of licensure of
other teachers
instructing in ELA:
Total number of
English instructors:
Number of licensed
English teachers:
Type of staff utilized:
__School day full-time
__School day part-time
__Outside contractors
__Other
(please
specify):
Number of licensed
English teachers:
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:
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):
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Name of Grant Program: Academic Support Services Allocation Grant
Program
Fund Code: 632 (School Year)
625 (Summer)
ii. Mathematics
School Year (for Fund Code: 632 applications)
Mathematics
Summer (for Fund Code: 625 applications)
Mathematics
Total number of
mathematics
instructors:
List areas of licensure of
other teachers
instructing in
mathematics:
Total number of
mathematics
instructors:
List areas of licensure of
other teachers instructing
in mathematics:
Number of licensed
mathematics teachers:
Type of staff utilized:
__School day full-time
__School day part-time
__Outside contractors
__Other
(please
specify):
Number of licensed
mathematics teachers:
Type of staff utilized:
__School day full-time
__School day part-time
__Outside contractors
__Other (please specify):
Indicate the amount of
planning time per hour
of teaching:
Indicate the amount of
planning time per hour
of teaching:
Student to teacher ratio
(cannot exceed 10:1):
Student to teacher ratio
(cannot exceed 10:1):
iii. Science and Technology/Engineering
School Year (for Fund Code: 632 applications)
Science and Technology/Engineering
Total number of
science and tech/eng.
Instructors:
Number of licensed
science and tech/eng.
teachers:
Indicate the amount of
planning time per hour
of teaching:
List areas of licensure of
other teachers
instructing in science
and tech/eng.:
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):
iv.
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.:
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):
Indicate the amount
of planning time per
hour of teaching:
Student to teacher ratio
(cannot exceed 10:1):
Indicate the qualifications of those responsible for direct services not listed above.
____Check if not applicable.
Name of Grant Program: Academic Support Services Allocation Grant
Fund Code: 632 (School Year)
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Program
IV.
625 (Summer)
OUTCOMES / DATA & EVALUATION REQUIREMENTS*
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 2013 will be similar to the
information submitted regarding the fiscal year 2012 programs.
Grantees must use the Evaluation Guidelines to prepare a narrative report on the overall effectiveness of the
program.
The Student Data information and the Evaluation Reports are both due July 31, 2013 for School Year programs
and September 30, 2013 for Summer programs.
Outcome(s): Describe the program’s anticipated improvements for students and/or staff that will be a
result of proposed activities noted in this application.
Anticipated
Outcome(s)
V.
How will it be measured?
Baseline # and/or %
Target # and/or
%
By When?
ADDITIONAL REQUIREMENTS
1. Assurance Document – must be completed if applicant will be serving students in the classes of 20152017.
2. More information can be found in the Guidance Documents in the Additional Information section of the
Funding Opportunity (RFP) document.
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