Names of Grant Programs:
1. Expanded Learning Time (ELT)
2. Massachusetts 21st Century Community Learning Centers
– Supporting Additional Learning Time (ELT and OST)
Fund Codes:
1. 225-C
2. 647-B1
PART III – REQUIRED PROGRAM INFORMATION
I.
Descriptions of Grant-Allowable Models for Adding Time
II.
District Cover Sheet
III.
District Summary
IV.
School/Site Summary
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I.
Descriptions of Grant-Allowable Models for Adding Time
Please see the respective FO-RFP for additional details about each of these options, including maximum
funding request amounts.
If Choosing…
May apply through…
Fund Code 225-C
(FC 225-C)
Expanded Learning
Time (ELT)
Fund Code 647-B1
(FC 647-B1)
Out-of-School Time
Fund Code 647-B1
(OST)
(FC 647-B1)
Basic Description/Requirements
For all students: Applicants will establish a school
schedule, required for all students, that adds a
substantial amount of additional hours to the school
day, week and/or year so that they offer at least
300 hours above the state minimum
requirements
For all students: Applicants will establish a longer
school day, week, and/or year that increases the
total number of school hours required for all
students by a minimum of 180 hours above the
amount offered in either FY13 or FY14.
For targeted students: Applicants choosing this
option will offer a total of a minimum of 448 hours of
OST programming during the school-year and
summer for a targeted group of students.
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II.
DISTRICT COVER SHEET
IMPORTANT NOTES:
 If applying for funding through both FC 225-C and FC 647-B1, please complete the district cover sheet (II) and district summary (III) once and include
it with both applications.
 If the lead applicant is not a district (FC 647-B1 only), it should work with the district to complete the district cover sheet (II) and district summary (III)
sections.
Applicant (District/Agency):
District/Agency Contact Name:
Phone:
Email:
Fund Code and Model for Adding Time
Proposed School(s)/Site(s)
Include below all schools/sites proposed through either
FC 225-C and FC 647-B1.
FC 225-C:
ELT
FC 647-B1:
Model 1 (ELT)
FC 647-B1:
Model 2 (OST)
Total Request
Competitive Priority:
(Please put an ‘x’ in the box if applicable)
Amount Requested*
Please place an ‘x’ in the appropriate box for each school/site
proposed.
School
Year
Summer
Total
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
[For FC 647-B1 Model 2 (OST) Applicants Only] Districts that have not received 21st CCLC
funding within at least the past three years (FY12-FY14).
Additional Time Offered at Other District Schools/Sites
(Please list any schools/sites in the district that currently offer ELT or OST, regardless of
whether funded through FC 647 or FC 225. Add rows as needed.)
Total Additional
Hours Offered
Annually
Model for Additional Time
ELT
OST
(for all students)
(for targeted students)
*Please see the FO-RFP documents for maximum funding request amounts.
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III.
DISTRICT SUMMARY
Instructions: Please address each of the following questions within the indicated page limits. Responses should
be provided within this document, without changing the format or font size, and leaving the questions above each
response.
A. District Process and Rationale for Adding Time (3 pages maximum):
1. Identify the elements of the district’s existing improvement, turnaround and/or other strategic plans that
will be addressed through the proposed additional time.
2. Describe the reasons for proposing the school(s)/site(s) included in this application (as opposed to
another/others in the district, if there is more than one school in the district).
3. Describe lessons learned from past experiences running ELT and/or OST programs, how those lessons
have been applied to this application, and what will be different about this program compared to the
previous one(s).
a. [FC 647-B1 Model 2 (OST) ONLY, If the proposed school/site received 21st CCLC OST
funding during any of the following years: FY10-FY13]). Please indicate whether after-school
program(s) continued to operate at the proposed school(s)/site(s), even if at a reduced level.
(REMINDER: Any school/site that received funding during FY14 is not eligible to apply for a FY15
FC 647-B1 grant.)
 If yes, describe the current program.
 If no, explain why not.
B. District Support and Sustainability (3 pages maximum): Describe preliminary plans for supporting and
sustaining additional time. Your response must include:
1. A description of the ways in which the district/lead applicant will collaborate with the school(s)/site(s) to
support implementation of additional time, including in making budgetary decisions.
2. [FC 225-C and FC 647-B1 Model 1 (ELT) ONLY] A description of plans for negotiating collective
bargaining agreements to maximize financial support for additional time, if applicable.
3. [FC 225-C and FC 647-B1 Model 1 (ELT) ONLY] A description of how current organizational priorities
may be streamlined to allow for the reallocation of resources and support structures for additional time, if
applicable.
4. A description of the ways in which partners with shared priorities will support the success and
affordability of additional time.
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5. A description outlining plans to seek and secure additional funding from sources other than this grant, to
support both implementation and sustainability of the added time, including:
a. how the district/applicant will coordinate this grant with other federal, state and local programs
with compatible/complementary services (e.g., Academic Support, McKinney-Vento, Title I, Title
III, Adult Basic Education, Gateway Cities, Wrap Around Zones, Mass Grad, etc.); and
b. any planned/anticipated support (financial and other) from municipalities, counties, school
districts, and/or private/community foundations.
c.
Also complete the chart below with anticipated costs associated with adding time at the proposed
school(s)/site(s), as well as possible funding sources that will be used to support these costs.
Funding Category
Anticipated FY15
Costs (associated
with adding time)
Possible source(s) for supporting these
costs (federal, state, local, private, etc.)
Staffing (including, but
not limited to, instructional
staff, planning time,
substitutes, etc.)
Professional
Development
Partners/Vendors
Materials/Supplies
Transportation
Other: (please describe
below)
TOTAL ANTICIPATED
FY15 COSTS
Note: Level 2-5 districts are permitted to use their Title I, Part A reservation funds [formerly supplemental
educational services (SES) and public school choice set-aside funding] to support district/student needs as
assessed in relation to the
Conditions for School Effectiveness. This means that a district can choose to direct
part or all of its Title I, Part A allocation (which could also include Title II, Part A funds flexed into Title I, Part A) to
support additional time in one or more schools, if the district determines that will best meet the needs of the
district's lowest performing students.
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IV.
SCHOOL/SITE SUMMARY
IMPORTANT NOTES:
 Applicants should submit a separate School/Site Summary (IV, pages 6-14) for each school/site included in the
proposal. Applicants may request funds for only one model for adding time per school/site proposed, and:
o Up to two school(s) through FC 647-B1, Model 1 (ELT); and
o A maximum of one school/site through FC 647-B1, Model 2 (OST).
 The same school(s)/site(s) may not be proposed under both FC 225-C and FC 647-B1.
School/Site Name:
School/Site Contact Name:
Phone:
Competitive
Priority:
(Place an ‘x’ in the
box for each that
apply.)
Email:
[FC 225-C ONLY] Highest competitive priority will be given to proposals
requesting a maximum of $800.00 per pupil from this grant. Grant funds will be
used to support implementation of at least 300 hours of additional time, and
where necessary, applicants must include a proposal to support other
anticipated costs associated with implementing ELT that will not be covered
using grant funds.
Proposing to implement more time in a school designated as Level 3, 4, or 5
under Massachusetts' district and school accountability and assistance system
Please indicate
Proposing to serve youth in schools/communities with
the % below:
higher percentages of families with low income, as
indicated at the Department's School and District profiles
page (http://profiles.doe.mass.edu/).
Proposing targeted strategies to support reading proficiency by grade 3 and/or
successful transition into grade 9. Note: Proposed grant activities that will support this
priority should be clearly outlined in the responses to Section D below.
Submitting this application in full partnership that includes a school district, and
a community-based organization(s) or other public or private entity(ies).
The following competitive priorities apply to ELT Applicants Only
[FC 225-C and FC 647-B1 Model 1 (ELT)]
Proposing a year-round school model or at least a substantial amount of time
for all students during the summer.
Proposing the use of blended learning strategies.
Proposing to add time at a middle school.
Instructions: Please address each of the following questions within the indicated word/page limits. Responses
should be provided within this document, without changing the format or font size, and leaving the questions
above each response.
A. Process and Rationale for Additional Time: (3 pages maximum)
a. Identify the school’s/site’s specific needs and priorities related to student learning (including academic,
social-emotional, wellness, etc.) that will be addressed through the proposed additional time.*
*Note: The school’s needs/priorities should be identified from existing school improvement, turnaround, or other
plans guiding current work. Schools should use the Conditions for School Effectiveness as benchmarks against
which to gauge practice in key areas.
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b. Identify the school’s/site’s structures and processes for planning for, implementing and monitoring
additional time to better meet student needs. Include a description of the planning team that developed
this proposal, and their respective roles. Describe how stakeholders were and will be involved in planning
and implementing additional time. [FC 647-B1 Applicants ONLY] Complete Addendum B describing the
required advisory community council/group.
c.
Describe the reasons for choosing to implement additional time using the selected model (ELT or OST.)
Include how data was used to support decisions related to the selected model as well as the
programming/activities to be implemented.
B. Accountability and Evaluation (1 page maximum): Describe previous experience with program evaluation.
NOTE: All FC 647-B1 grantees are required to use the Survey of Academic Youth Outcomes (SAYO)
evaluation instrument developed by the Department and the National Institute on Out-of-School-Time (NIOST).
Upon approval, grantees will be required to customize and select specific SAYO outcomes, and will be
provided with the tool and training on its implementation. For more information on the SAYO tool, see:
http://www.doe.mass.edu/21cclc/ta/sayo.html.
C. [FC 647-B1 ONLY] Proposed Typical Day (1 page maximum): Provide a narrative summarizing what a
typical day that includes additional time will look like at the proposed school/site. This summary should
highlight proposed creative and innovative practices and give grant reviewers an idea of how students will
experience their newly expanded day as a result of this grant. The specifics of implementation are provided in
the next question.
D. Implementing Additional Time (10 pages maximum, including charts):
a. [FC 647-B1 Model 2 (OST) ONLY] Describe the specific targeted population to be served through grantfunded programming/activities.
i. Describe planned outreach strategies to recruit and retain the students targeted for participation in the
proposed OST program.
b. [ALL APPLICANTS] Using the four charts on the following pages, describe the proposed activities (made
possible with additional time, and in particular by this grant) that align with school priorities and the
targeted needs related to:*
1. engaging instructional practices,
2. professional development and teacher collaboration,
3. enrichment opportunities, and
4. school-community partnerships.
*See the Planning Resources in the FO-RFP under Grant Requirements for more information about encouraged
grant activities and areas to consider in program design.
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1. Engaging Instructional Practices: One priority of this grant is to use additional time to develop creative and innovative opportunities to
accelerate student learning and deepen engagement. Applicants should include how the school/site will incorporate service-learning, inquirybased learning and/or project-based learning as an instructional strategy. The Department will provide training to support this required
component of the grant.
Proposed Activities to be Implemented Using
Additional Time:
Describe the additional or enhanced opportunities for
engaging instruction that will be provided as a result of
adding time, and in particular as a result of this grant.
Needs/Priorities Addressed:
Describe how the proposed activities support
school/district priorities, meet an identified need and/or
gap in services, and/or expand current program
offerings.
Note: The need may include insufficient time to fully
implement current promising practices in this area. If
so, please describe those practices.
Budget Justification:
Describe how requested grant funds will support the
proposed activities described in this area.
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2. Professional Development (PD) and Teacher Collaboration: One priority of this grant is to maximize additional time in order to embed
opportunities for teachers, staff and providers to collaborate and to continuously improve practices.
Proposed Activities to be Implemented Using
Additional Time:
Describe the opportunities for and structure of
professional development and teacher collaboration
that will be provided or enhanced by adding time, and
in particular as a result of this grant.
Note: Describe plans to include contracted
providers/partners/volunteers that will be working
directly with students in PD and collaborative efforts.
Needs/Priorities Addressed:
Describe how the proposed activities support
school/district priorities, meet an identified need and/or
gap in services, and/or expand current program
practices.
Note: The need may include insufficient time to fully
implement current promising practices in this area. If
so, please describe those practices.
Budget Justification:
Describe how requested grant funds will support the
proposed activities described in this area.
Note: [FC 647-B1 ONLY] Applicants should include
funds to support the program coordinator’s attendance
at a two-day 21st CCLC Summer Institute typically held
in July, sponsored by the US Department of Education.
Conference participants are responsible for airfare,
hotel and other travel-related expenses.
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3. Engaging Enrichment Opportunities: One priority of this grant is to provide additional creative, innovative and engaging enrichment opportunities
for students beyond traditional academics; as well as opportunities that support social-emotional learning, wellness, civic engagement, etc.
Enrichment opportunities should be thoughtfully planned to integrate academics and other skills for college and career readiness.
Proposed Activities to be Implemented Using
Additional Time:
Describe the additional opportunities for engaging
enrichment that will be provided by adding time, and in
particular as a result of this grant.
Include any specific grant-funded activities that will
support the social/emotional needs of the students
served.
Needs/Priorities Addressed:
Describe how the proposed activities support
school/district priorities, meet an identified need and/or
gap in services, and/or expand current program
offerings.
Note: The need may include insufficient time to fully
implement current promising practices in this area. If
so, please describe those practices.
Budget Justification:
Describe how requested grant funds will support the
proposed activities described in this area.
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4. School-Community Partnerships: One priority of this grant is to support and strengthen partnerships among schools/sites, families and
communities that advance common goals for student success.
Proposed Activities to be Implemented Using
Additional Time:
Describe the additional opportunities for building and
strengthening partnerships that will occur as a result of
adding time and in particular of this grant.
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.
Use Addendum F to include a budget and budget
narrative for each contracted provider.
Needs/Priorities Addressed:
Describe how the proposed activities support
school/district priorities, meet an identified need and/or
gap in services and/or expand current program
offerings.
Note: The need may include insufficient time to fully
implement current promising practices in this area. If
so, please describe those practices
Budget Justification:
Describe how requested grant funds will support the
proposed activities described in this area.
[FC 647-B1 ONLY] Note: In this section, please be
sure to include the proposed family engagement
activities, as well as a description of the specific
related family engagement expenditures (which
must total a minimum of 5% of the grant request).
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E. Schedule
[FC 225-C and FC 647-B1 Model 1 (ELT) ONLY] (5 pages maximum):
a. Use the chart below to provide information about school hours (required for all students) currently in FY14
(2013-2014), and projected for FY15 (2014-2015):
SAMPLE YEAR
Date school began:
Start/End Time
8:15 – 2:15
8:15 – 12:15 (early release days)
FY14 (2013-2014)*
Date school ends:
9/2/2014
Hours
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TOTALS
Date school began:
Current Enrollment
# of days
170
10
180
6/19/2015
Total Hours
1020
40
1080
Date school ends:
Current Grades Served:
School Start/End Time [insert rows if needed]
Hours
# of days
Total Hours
TOTALS
PROJECTED FOR
FY15 (2014-2015)
Date school begins:
Anticipated
Enrollment:
Date school ends:
Anticipated Grades
Served:
School Start/End Time [insert rows if needed]
Hours
# of days
Total Hours
TOTALS
b. [FC 225-C and FC 647-B1 Model 1 (ELT) ONLY] Provide the following schedules: (please insert schedules
into this document)
i. Current Student Schedule (FY14)*
ii. Current Teacher Schedule (FY14)*
iii. Proposed Student Schedule (FY15)
iv. Proposed Teacher Schedule (FY15)
* FC 647-B1 Model 1 (ELT) ONLY Also provide this information for FY13 (2012-2013), if time was added in
FY14.
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[FC 647-B1 Model 2 (OST) ONLY] (2 pages maximum)
a. Use the charts below to provide information about the proposed OST program schedule. NOTE: Please see
below for important guidelines/requirements for OST program operation.
Anticipated
# Youth to
be Served
#
Hours /
week
#
Weeks
Total
#
Hours
Days of
Week
(e.g., M-F)
Program Times
Start Time:
School Year
(before school)
End Time:
Start Time:
School Year
(after school)
End Time:
Start Time:
Summer
End Time:
Total # of Hours Offered:
b. Describe the student attendance policy for the proposed 21st CCLC OST and summer program. Include for
both how often students are required to attend.
c.
Describe the location and space in which the OST program will take place. Describe how the space and
environment will be welcoming, have the necessary resources to fully implement program activities, stimulate
learning, and provide space to exhibit students' work and projects. Please refer to the Grant Assurances
document regarding space requirements.
d. Describe how the program will meet the United States Department of Agriculture (USDA) National School
Lunch Program requirements for meal supplements, in offering a daily nutritious snack and breakfast (if
offering a morning/before-school program).
e. Summer Program Description: Provide a brief description of plans for implementing the required summer
program.
All FC 647-B1 grantees proposing OST must adhere to the following guidelines:
 Hours of Operation Options: In general, programs must offer a minimum of 8 hours per week during the
school year. The following are recommended options for program hours; however programs may also
propose something different, so long as the required minimum number of hours are offered.
School Year Minimum
Summer Minimum
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.]



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.
Students must attend the offered school year programming for, on average, a minimum of 100 hours
(elementary), 90 (middle) and 80 (high).* Drop-in programs are not allowed.
*Required average hours are based on MA 21st CCLC statewide data. Vacation week programs may not be
counted towards total hours unless serving the same students that attend the OST program.
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F. Transportation (1 page maximum):
[FC 647-B1 Model 2 (OST) ONLY – for both school-based and/or off-site programs]
As required by federal legislation describe how will you ensure that students travel safely to and from the OST
program and home.
G. Staffing (2 pages maximum):
a. [FC 225-C and FC 647-B1 Model 1 (ELT) ONLY]
i. Briefly describe how ELT will impact staffing levels and schedules and what flexibilities the school has in
this area to enable effective and cost-effective implementation of ELT.
ii. Please provide a description of any necessary changes that were/will be made in collective bargaining
agreements, school charters, or in other areas that affect the proposed ELT. Where applicable, schools
must include documentation of changes to collective bargaining agreements, charters, etc.
iii. If applicable, describe how qualified volunteers will be used to support proposed activities.
b. [FC 647-B1 Model 2 (OST) ONLY] All staff must meet the qualifications listed in the Grant Assurances
document.
i. Describe the qualifications/staff credentials the program will be seeking for the required positions below:
 Program/Site Coordinator (If the program coordinator position has been designated describe their
qualifications)

Program staff
ii. Describe how staff has the required qualifications, training and support to meet the needs of the targeted
population including students on IEPs, and English Language Learners.
iii. Include the anticipated student-to-staff ratios, and plans for quality personnel recruitment and retention.
iv. Describe plans to provide CPR and first aid (at least within two months of employment) to program staff.
v. If applicable, describe how qualified volunteers will be used to support proposed activities
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