PI-9550-ID Title I, Part D, Subpart 2 Neglected and Delinquent by 6EWmI2Cs

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									                 Wisconsin Department of Public Instruction                   INSTRUCTIONS: Submit original and two (2) copies. Application
                 TITLE I, PART D, SUBPART 2—NEGLECTED AND                     must be received or postmarked no later than AUGUST 31, 2011.
                 DELINQUENT PROGRAM APPLICATION                               Return to:
                 PI-9550-ID (Rev. 05-11)                                         WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION
                                                                                 TITLE I AND SCHOOL SUPPORT TEAM
                                                                                 ATTN: TERRY BOEHNER
                                                                                 P.O. BOX 7841
Fiscal Year 2011-12                                                              MADISON, WI 53707-7841

                                                           I. GENERAL INFORMATION
Applicant Agency                                            Mailing Address Street, City, State, ZIP



Contact Person                                                                               Title



E-Mail Address                                                                               Phone Area/No.            Fax Area/No.



Program Coordinator If other than contact person.                                            Title



E-Mail Address                                                                               Phone Area/No.            Fax Area/No.



Program Coordinator’s Mailing Address Street, City, State, ZIP                                                   Grant Period
                                                                                             Beginning Date Mo./Day/Yr. Ending Date Mo./Day/Yr.



Total Funds Requested         Local Match                   Project Title

                                                                 Title I Prevention and Intervention Services for Neglected and
                                                                 Delinquent or At-Risk Children and Youth
Page 2                                                                                                                           PI-9550-ID

                                                             II. ASSURANCES

Assurance is hereby provided that:
 1. The programs and services provided under this grant will be used to address the needs set forth in the application and fiscal
    related information will be provided within the fiscal year timelines established for new, reapplying, and/or continuing programs.
 2.   The programs and services provided with federal funds under this grant will be operated so as not to discriminate on the basi s of
      age, gender, race, national origin, ancestry, religion, creed, pregnancy, marital or parental status, sexual orientation, or physical,
      mental, emotional, or learning disabilities.
 3.   Administration of the program, activities, and services covered by this application will be in accordance with all applicable state
      and federal statutes, regulations, and the approved application.
 4.   The activities and programs that will be performed under this grant will be used to supplement services and not supplant fund s
      from non-federal sources.
 5.   The district will require the entity and its principals involved in any subtier covered transaction paid through federal fund s, that
      requires such certification, to ensure it/they are not debarred, suspended, proposed for debarment, declared ineligible, or
      voluntarily excluded from participation by a federal department or agency. {EDGAR-Part 85}
 6.   The local educational agency (LEA) will evaluate its program periodically to assess its progress toward achieving its goals and
      objectives and use its evaluation results to refine, improve, and strengthen its program and to refine its goals and objectives as
      appropriate.
 7.   The LEA will submit to the department such information, and at such intervals, that the department requires to complete state
      and/or federal reports.
 8.   This program will be administered in accordance with all applicable statutes, regulations, program plans, and applications.
 9.   The school district will cooperate in carrying out any evaluation of this program conducted by or for the state education agency,
      the secretary, or other federal officials.
10.   The school district will comply with civil rights and nondiscrimination requirement provisions and equal opportunities to par ticipate
      for all eligible students, teachers, and other program beneficiaries.
11.   The school district will use fiscal control and fund accounting procedures that will ensure proper disbursement of, and accounting
      for, federal funds received and distributed under this program.
12.   The school district will (a) make reports to the Department of Public Instruction and the U.S. Secretary of Education as may be
      necessary to enable the state and federal departments to perform their duties under this program; and (b) maintain records,
      provide information, and afford access to the records, as the department or the U.S. Secretary of Education may find necessary
      to carry out their duties.
13.   Each agency receiving funds under this grant shall use these funds only to supplement, and not to supplant , state and local
      funds that, in the absence of such funds, would otherwise be spent for activities under this section.
14.   The applicant will file financial reports and claims for reimbursement in accordance with procedures prescribed by the
      Department of Public Instruction.
15.   The applicant will file quarterly American Recovery and Reinvestment Act (AARA) of 2009 financial reports and claims for
      reimbursement in accordance with procedures prescribed by the Department of Public Instruction.
16.   No board or staff member of an LEA will participate in, or make recommendations with respect to, an administrative decision
      regarding a program or project if such decision can be expected to result in any benefit or remuneration, such as a royalty,
      commission, contingent fee, brokerage fee, consultant fee, or other benefit to him or her or any member of his/her immediate
      family.
17.   Before the plan was submitted, the school district afforded a reasonable opportunity for public comment on the plan and has
      considered such comment.
18.   Any printed (or other media) description of programs will state the total amount being spent on the project or activity and will
      indicate the percentage of funds from the federally funded programs.
19.   The school district will adopt and use proper methods of administering such program, including (a) the enforcement of any
      obligations imposed by law on agencies, institutions, organizations, and other recipients responsible for carrying out each
      program; or (b) the correction of deficiencies in program operations that are identified through audits, monitoring, or evaluation.
20.   The school district will administer such funds and property to the extent required by the authorizing statutes.
21.   The LEA assures it will administer in accordance with applicable statues, regulations, program plans, and budgets the funds
      under Title I, Part A of the Elementary Secondary Education Act of 1965 made available under ARRA (P.L. 111-5).
22.   The LEA assures it will administer funds in accordance with applicable statutes, regulations, and program plans, and meet
      requirements for quarterly reporting and accountability to ensure transparency of funds utilized under Title I, Part A of the
      Elementary and Secondary Education Act of 1965, made available under ARRA (P.L.111-5).
PI-9550-ID                                                                                                                                      Page 3

                                                                 II. ASSURANCES (cont’d)

Assurance is hereby granted that the
Institution which has entered in an agreement                                           (Legal Name)
with the LEA under section 1422(a) to provide services to neglected and/or delinquent youth under this section shall meet the following program
requirements (Section 1425).

 1. Where feasible, ensure educational programs in juvenile facilities are coordinated with the student’s home school, particularly with respect to
    special education students with an individualized education program.
 2. Notify the local school if a youth is identified as in need of special education services while in the facility.
 3. Where feasible, provide transition assistance to help the youth stay in school, including coordination of services for counseling, assistance, in
    accessing drug and alcohol abuse prevention programs, tutoring, and family counseling.
 4. Provide support programs which encourage youth who have dropped out to re-enter school once their term has been completed or provide such
    youth with the skills necessary for such youth to gain employment or seek a secondary school diploma or its recognized equivalent.
 5. Work to ensure such facilities are staffed with teachers and other qualified staff who are trained to work with children with disabilities and other
    students with special needs taking into consideration the unique needs of such children and students.
 6. Use, to the extent possible, technology to assist in coordinating educational programs between the juvenile facility and the community school.
 7. Where feasible, involve parents in efforts to improve the educational achievement of their children and prevent the further involvement of such
    children in delinquent activities.
 8. Coordinate funds received under this program with other local, state, and federal funds available to provide services to participating youths, such
    as funds under the Job Training Partnership Act, and vocational education funds.
 9. Coordinate programs operated under this subpart with activities funded under the Juvenile Justice and Delinquency Prevention Act of 1974 and
    other comparable programs, if applicable.
10. If appropriate, work with local businesses to develop training and mentoring programs for participating youth.


                                                             III. CERTIFICATION/SIGNATURES

 WE, THE UNDERSIGNED, CERTIFY that the information contained in this application is complete and accurate to the best of our knowledge; that
 the necessary assurances of compliance with applicable state and federal statutes, rules, and regulations will be met; and, that the indicated agency
 designated in this application is authorized to administer this grant.

 WE FURTHER CERTIFY that the assurances listed above have been satisfied and that all facts, figures, and representation in this application are
 correct to the best of our knowledge.
 Signature of Institution Administrator                                                                                   Date Signed Mo./Day/Yr.

 
 Signature of Applicant Agency Administrator                                                                              Date Signed Mo./Day/Yr.

 
 Signature of School Board Clerk If applicable                                                                            Date Signed Mo./Day/Yr.

 
Page 4                                                                                                                                            PI-9550-ID

                                                       IV. CERTIFICATION COVERING DEBARMENT

 Must be submitted for discretionary projects only. However, agencies receiving funds under any of the other grant programs must collect this
 certificate whenever they enter into a covered transaction with a grantee. (Refer to instructions for more information.)
                                                                  Certification Regarding

                                            Debarment, Suspension, Ineligibility, and Voluntary Exclusion

                                                             Lower Tier Covered Transactions

 This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 34 CFR Part 85, Section 85.510,
 Participants' responsibilities. The regulations were published as Part VII of the May 26, 1988, Federal Register (pages 19160-19211). Copies of the
 regulations may be obtained by contacting the person to whom this proposal is submitted.

 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended,
    proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall
    attach an explanation to this proposal.

 LEA/Agency/Company Name



 Name and Title of Authorized Representative



 Signature                                                                                                                     Date Signed Mo./Day/Yr.

 
                                                          V. INSTRUCTIONS FOR CERTIFICATION

1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below.
2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later
   determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the
   Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or
   debarment.
3. The prospective lower tier participant shall provide immediate written notice to the person to whom this proposal is submitted if at any time the
   prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed
   circumstances.
4. The terms "covered transaction,” "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered
   transaction,” "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and coverage
   sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a
   copy of those regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not
   knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from
   participation in this covered transaction, unless authorized by the department or agency with which this transaction originated.

6. The prospective lower tier participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding
   Debarment, Suspension, Ineligibility, and Voluntary Exclusion-Lower Tier Covered Transaction," without modification, in all lower tier covered
   transactions and in all solicitations for lower tier covered transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not
   debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant
   may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the
   Nonprocurement List (202-786-0688).
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification
   required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent
   person in the ordinary course of business dealings.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier
   covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to
   other remedies available to the federal government, the department or agency with which this transaction originated may pursue available remedies,
   including suspension and/or debarment.
PI-9550-ID                                                                                                                               Page 5

                                                                VI. ABSTRACT
 Summarize the key elements necessary to communicate the purpose of this grant. Include all the key summary points necessary to communicate the
 overall purpose for requesting grant funds. See Section 1421(1)(2)(3).
Page 6                                                                                                                                        PI-9550-ID

                                                             VII. STATEMENT OF NEED
Provide background data and related information to justify the selection of this project. The narrative will provide the reader with sufficient evidence
that this project is of such size, scope, and quality as needed to be effective. Be specific. Show examples.




                                                             VIII. GOALS/OBJECTIVES
Identify goals that are based upon a thorough assessment of objective data about the project. Goals may be valid for multiple years. When
developing goals, keep in mind the overall purpose of the project. Consider the following as general goal statements are written:
 Goals are not typically measurable yet describe the desired outcome.
 Goals should be logically related to some identified need.
 Goals should be clearly and succinctly written.
Objectives provide the framework by which a given goal is met, reduced, or satisfied. Clearly written objectives also provide the basis for future
evaluation activities. Objectives are measurable, time limited, logically related to goals, and describe outcomes for students, staff, families, etc.
PI-9550-ID                                                                                                                                              Page 7

                                                                       IX. NARRATIVE
Applicants for Title I, Part D, Subpart 2 funds for delinquent and at-risk pupils served in the district or local institution serving such children will respond
to questions 1-13; applicants for neglected programs will answer questions 1, 5, 6, 7, and 13.

For each of the items listed, provide a written description of how the project will address the specifics of that item. The responses should follow the
numbering sequence of the items with boldface headings used to identify the responses. The application should be concise and to the point.

Narrative responses should be provided to describe plan of service for delinquent children residing in correctional facilities.

 1.   Formal Agreements. Describe the formal agreements between the local education agency, correctional facilities, and alternative school
      programs serving youth involved with the juvenile justice system to operate programs for delinquent youth. Section 1423(A)(B)


 2.   Coordination of Effort. As appropriate, describe how the participating school will coordinate with facilities working with delinquent youth to
      ensure that such youth are participating in an educational program comparable to the one operating in the local school such youth would attend.
      Section 1423(3)


 3.   Dropout Prevention. As appropriate, describe the dropout prevention program operated by participating schools and the types of services such
      schools will provide to at-risk youth in participating schools and youth returning from correctional facilities. Section 1423(4)


 4.   Youth Expectations. A description of the characteristics (including learning difficulties, substance abuse problems, and other special needs of
      the children and youth who will be returning from correctional facilities and, as appropriate, other at-risk children and youth expected to be served
      by the program, and a description of how the school will coordinate existing educational programs to meet the unique educational needs of such
      children.


 5.   Coordination with External Sources. As appropriate, describe how schools will coordinate with existing social and health services to meet the
      needs of students at risk of dropping out of school and other participating students, including prenatal health care and nutrition services related to
      the health of the parent and child, child development classes, child care, targeted re-entry and outreach programs, referrals to community
      resources, and scheduling flexibility. Section 1423(6)


 6.   Business Partnerships. As appropriate, describe, if any, partnerships with local businesses to develop training, curriculum-based youth
      entrepreneurship education, and mentoring services for participating students. Section 1423(7)


 7.   Parental Involvement. As appropriate, describe how the program will involve parents in efforts to improve the educational achievement of their
      children, assist in dropout prevention activities, and prevent the involvement of their children in delinquent activities. Section 1423(8)


 8.   Coordination with Other At-Risk Programs. Describe how the program under Title I, Part D, Subpart 2, will be coordinated with other federal,
      state, and local programs such as programs under Title I of Public Law 105-220 and vocational education programs serving this at-risk population
      of youth. Section 1423(9)


 9.   Coordination with the Juvenile Justice and Delinquency Act. Describe how the program will be coordinated with programs operated under
      the Juvenile Justice and Delinquency Prevention Act of 1974 and other comparable programs, if applicable. Section 1423(10)


10.   Assistance from Probation Officers. As appropriate, describe how schools will work with probation officers to assist in meeting the needs of
      youth returning from correctional facilities. Section 1423(11)


11.   Individualized Education Program Awareness. Describe the efforts that participating schools will make to ensure correctional facilities working
      with youth are aware of a child’s existing individualized education program. Section 1423(12)


12.   Procedure(s) for Alternative Placements. As appropriate, a description of the steps schools will take to find alternative placements for youth
      interested in continuing their education but unable to participate in a regular public school program. Section 1423(13)


13.   Professional Development Plan. Describe the professional development plan for the ensuing year. Specify goals, planned activities and
      strategies, who the participants will be, and how effectiveness will be determined.
Page 8                                                                                                                                         PI-9550-ID

                                                                     X. BUDGET SUMMARY

 Applicant Agency                                                         Grant Period                             Date Submitted
                                                                   Beg.                        Initial Request     First Revision      Second Revision


 Project Number For DPI Use Only                                   End


Budget Revisions: Submit a copy of this page, with appropriate revisions included. (Attach this to a brief letter of justification.) Note: Submit request
at least 30 days prior to expenditure of grant monies. June 30 is the final date for submission of revisions. All fields must have an entry to calculate
properly. If the amount is zero, make sure to enter a zero in that field.

       WUFAR Function                            WUFAR Object                     Amount Requested          First Revision          Second Revision
                                     a. Salaries (100s)

 Instruction                         b. Fringe Benefits (200s)
 (100 000 Series)
                                     c. Purchased Services (300s)
 Activities dealing directly with
 the interaction between             d. Non-Capital Objects (400s)
 instructional staff and
 students.                           e. Capital Objects (500s)

                                     f.   Other Objects (e.g., fees) (900s)

                                     TOTAL Instruction                                         $0                       $0                      $0
 Support Services—                   a. Salaries (100s)
 Pupil and Instructional Staff
 Services (in 210 000 and            b. Fringe Benefits (200s)
 220 000 Series)
                                     c. Purchased Services (300s)
 Support services are those
 which facilitate and enhance        d. Non-Capital Objects (400s)
 instructional or other
 components of the grant. This       e. Capital Objects (500s)
 category includes staff
 development, supervision, and
                                     f.   Other Objects (e.g., fees) (900s)
 coordination of grant activities.
                                     TOTAL Support Services—                                  $0
                                     Pupil/Instructional Staff Services
                                                                                                                       $0                       $0
                                     a. Salaries (100s)

 Support Services—                   b. Fringe Benefits (200s)
 Administration
                                     c. Purchased Services (300s)
 (Associated with functions in
 230 000 series and above.)          d. Non-Capital Objects (400s)
 Includes general; building;
 business; central service           e. Capital Objects (500s)
 administration; and
 insurances.                         f.   Insurance (700s)

                                     g. Other Objects (e.g., fees) (900s)

                                     TOTAL Support Services—Admin.                            $0                       $0                        $0

 Indirect Cost                       Approved Rate             %

                                     Current Entitlement

 Available Funding                   Estimated Carryover

                                     TOTAL Available Funding                                  $0                       $0                       $0
 Unbudgeted Funds                    TOTAL Unbudgeted Funding

 TOTAL BUDGET                                                                                 $0                       $0                       $0

 DPI Approval                        DPI Reviewer Signature/Date              
PI-9550-ID                                                                                                                          Page 9
                                                            XI. BUDGET DETAIL
 Date of Request Mo./Day/Yr.   Applicant Agency                                             Project No. For revisions only



                                                   1. Purchased Services Summary (300s)
       a.                     b.                           c.                               d.                                e.
   WUFAR                    Type of               Date(s) Service to be     Specify Agency/Vendor or Supplier
 Function Code        Service Purchased                 Provided                        If Known                             Cost

                                                          —

                                                          —

                                                          —

                                                          —

                                                          —

                                                          —

                                                          —

                                                          —

                                                          —

                                                          —

                                                          —

                                                          —

                                                          —

                                                          —

                                                                                                            Total
                                                                                                                                     $0
                                                    (Must agree with Purchase Services Total on Budget Summary)
Page 10                                                                                                                             PI-9550-ID
                                                           XI. BUDGET DETAIL (cont’d)
Date of Request Mo./Day/Yr.        Applicant Agency                                                        Project No. For revisions only



                                                      2. Non-Capital Objects Summary (400s)
             a.
         WUFAR                b.                                                 c.                                               d.
      Code Function
 (Indicate for each item                                                     Item Name                                          Total
   listed in column c.)    Quantity                                  Include all items budgeted.                                Costs




                                                                                                                 Total
                                                         (Must agree with Non-Capital Objects total on Budget Summary)                  $0
                                                        3. Capital Objects Summary (500s)
             a.
         WUFAR                b.                                                 c.                                               d.
      Code Function
 (Indicate for each item                                                     Item Name                                          Total
   listed in column c.)    Quantity                                  Include all items budgeted.                                Costs




                                                                                                               Total
                                                           (Must agree with Capital Objects total on Budget Summary)
                                                                                                                                        $0
Page 11                                                                                                                                                                                 PI-9550-ID

                                                                                XI. BUDGET DETAIL (cont’d)
Date of Request Mo./Day/Yr.                        Applicant Agency                                                                                  Project No. For revisions only



                                                                             4. Personnel Summary (100s-200s)
                                                      All staff must hold the appropriate license. Must enter a “0” if field has no data.
                         List all employees to be paid from this project. If a vacancy exists which will be filled, indicate “vacant.” Send update on filled position.
          a.                            b.                                                c.                               d.                 e.                              f.
      WUFAR
   Function Code
 (Indicate for each                                                                                                      Project       Date(s) Service                   Total Cost
   position listed)                   Name                                          Position/Title                        FTE          to be Provided           Salary                Fringe
                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —

                                                                                                                                               —


                                                                                                                                   Total Salary & Fringe                 $0                    $0

								
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