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Application Package
West Virginia 21st Century Community Learning Center (21stCCLC) Program
Ninth Annual Grant Competition
Anticipated funding: July 1, 2012
provided by
The West Virginia Department of Education
http://21stcclc.k12.wv.us/
with funding from
The U.S. Department of Education
http://www.ed.gov/21stcclc
http://www.afterschool.gov
Minimum Funding of $50,000
Maximum Funding of $215,000
APPLICATION DUE DATE
The original application, four copies and an electronic copy must be received
by 3 p.m., Friday, April, 27 ,2012, at the office of
Dr. Marsha Bailes, Assistant Director
West Virginia Department of Education
Building 6, Room 617
1900 Kanawha Blvd., East
Charleston, WV 25305
Email: mcbailes@access.k12.wv.us
Expansion Grant Applicants
Applicants who are seeking expansion funding must submit this page in the order listed on “The
Application Checklist” document. Those eligible to apply for expansion funding are limited to
previously awarded subgrantees who did not receive the full funding requested in the approved
application. The intent of this funding is to permit successful programs to EXPAND on what they
are currently doing, not replace programming or sustain cuts in year four and five.
________ This submission is an expansion grant application. Our current program has evidenced
success in reaching annual goals and objectives as documented in this application.
Using data, show the increase you anticipate in at least one of the indicators listed below. Provide
current data to show the starting point and an estimate of the target the expansion grant will reach
(pre/post data).
Component Current Data Post-expansion Data Estimate
Student Average Daily
Attendance
Adult Participation
Program Components:
(please list to show what
expansion funds would add)
One expansion grant will be awarded, contingent upon funding from USDOE. The amount
awarded will be no less than $50,000 and no more than $71, 667. This money will expire in the
same year as the original grant award.
Program applying for expansion funding: ________________________________________
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TABLE OF CONTENTS
TABLE OF CONTENTS ........................................................................................3
2012 OVERVIEW ....................................................................................................4
GENERAL APPLICATION GUIDELINES ........................................................5
CONTENT OF APPLICATION ............................................................................8
COVER PAGES………………………………………………………………….15
APPLICATION CHECKLIST FORM ............................................................... 17
WV 21ST CCLC PROJECT SUMMARY AND ABSTRACT FORM ..............18
WVDE – 21st CCLC GRANT BUDGET FORM ................................................20
EXAMPLE BUDGET NARRATIVE ITEMS ....................................................21
ASSURANCE FORMS ..........................................................................................22
PRINCIPLES OF EFFECTIVENESS…………………………………………30
APPENDICES FORMS D, E, F………………………………………………..34
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2012 OVERVIEW
West Virginia Department of Education’s
st
21 Century Community Learning Center Grant Program
WHAT IS IT?
The West Virginia Department of Education (WVDE) is pleased to announce the ninth state 21st
Century Community Learning Center (21stCCLC) competition for grants. The intent of this federal
grant program is to provide opportunities for communities to establish or expand activities in
community learning centers that:
(1) provide opportunities for academic enrichment, including providing tutorial
services to help students, particularly students who attend low-performing
schools, to meet State and local student academic achievement standards in core
academic subjects, such as reading and mathematics;
(2) offer students a broad array of additional services, programs, and activities, such
as youth development activities, drug and violence prevention programs,
counseling programs, art, music, and recreation programs, technology education
programs, and character education programs, that are designed to reinforce and
complement the regular academic program of participating students; and
(3) offer families of students served by community learning centers opportunities
for literacy and related educational development.
This program is authorized under Title IV, Part B of the federal Elementary and Secondary
Education Act, H.R.-1. Allocations for each state are based upon the state’s student enrollment
and Title I participation. West Virginia expects to award approximately over one million dollars in
new 21st CCLC grants. By federal statute, a 21st CCLC grant may not be less than $50,000 per
year. This year each eligible program may receive up to $215,000. Awarded grants cannot exceed
5 years with descending funds in years 4 and 5 for successful programs. Expansion awards will be
no less than $50,000 and no more than $71, 667. These grants expire at the time of the original
grant, on which they are based, and do not decrease in years 4 and 5.
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GENERAL APPLICATION GUIDELINES
WHO CAN APPLY?
Public and private organizations may apply for funding. Examples of public and private
organizations include, but are not limited to: local education agencies, non-profit agencies, city and
county government agencies, faith-based organizations, institutions of higher education and for-
profit agencies.
Federal criteria require that states make awards to applicants that will primarily serve students that
attend schools with a high concentration of low-income students, giving priority to applicants
serving children in high-priority schools. We are defining high-poverty areas as schools with a
free or reduced lunch rate of 40% or more and low-performing schools as those that have
not met AYP for two or more consecutive years, or schools that serve as feeder schools to
those that have not met AYP for two or more consecutive years. Schools included in
applications must meet both of those requirements.
Applications may have a partner agency and submit a joint application from a Local Education
Agency (LEA) and at least one non- profit agency, city or county governmental agency, faith-
based organization, higher education institution or for-profit corporation. The lead agency may be
the LEA, the community-based organization, the faith-based organization or other
agency/institution, but the lead must always partner with at least one eligible school. The applicant
must provide evidence in Appendix F of planning with the partner agency during the creation of
the application, such as meeting agendas, sign-in sheets, etc. The partner must also be described in
the grant narrative as having significant, ongoing involvement in the program (as defined in the
Competitive Priorities section of this application).
HOW DO WE APPLY?
Participation in this Bidders’ Conference is strongly recommended, but not required, to
submit an application. To prepare an application, use the WV 21st CCLC Application Package
information available for download from the WVDE 21st CCLC web site at
http://21stcclc.k12.wv.us/. (For general 21st CCLC information, go to: www.ed.gov/21stcclc.)
Applicants are REQUIRED to notify WVDE by March 2, 2012, of their intent to apply for the
next competition of five-year 21stCCLC funding. Please send that notification in writing on
organization letterhead to Marsha Bailes at: mcbailes@access.k12.wv.us.
Completed applications must arrive at the West Virginia Department of Education’s 21st CCLC
office by 3:00 p.m. Friday, April 27. Applications will not be accepted if they are submitted after
the 3:00 p.m. April 27 deadline, an electronic version via email and required copies are not
submitted on time and/or the current application RFP has not been used.
WVDE will utilize a review process using individuals with diverse background and expertise to
evaluate the applications. Grant-award announcements will be made by July 1, 2012 with funding
also expected to begin that month. WVDE reserves the right to not award all grant monies and/or
to negotiate specific grant amounts. All awards are subject to the availability of federal funds. -
Grants are not final until a WVDE grant contract is fully executed.
To comply with ESEA Title IV Part B Section 4204 (b)(2)(L), each applicant must sign an
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assurance that the community was given notice of its intent to submit an application and that the
application and any waiver request be available for public review after submission of the
application. This form will comprise Appendix E.
FOR WHAT ACTIVITIES MAY A GRANTEE USE 21ST CCLC FUNDS?
Each eligible organization that receives an award may use the funds to carry out a broad array of
before- and after-school activities (including during summer recess periods) that advance student
achievement. In the view of the U.S. Department of Education and WVDE, local grantees are
limited to providing activities within the following list:
remedial education activities, including tutoring
homework help
academic enrichment learning programs, including providing additional assistance to
students to allow the students to improve their academic achievement
mathematics and science education activities
arts and music education activities
entrepreneurial education programs
mentoring programs
programs that provide after-school activities for limited English proficient students that
emphasize language skills and academic achievement
recreational activities
telecommunications and technology education programs
expanded library service hours
programs that promote parental engagement, family literacy, and adult skill
development
programs that provide assistance to students who have been truant, suspended, or
expelled to allow the students to improve their academic achievement
drug and violence prevention programs, counseling programs, and character education
programs
health and nutrition
Applicants are reminded of their obligation under section 504 of the Rehabilitation Act to ensure
that their proposed community learning centers program activities are accessible to persons with
disabilities.
WHAT ARE THE COMPETITIVE PRIORITIES?
Priority will be given to the following:
School(s) included in the following:
-The Combined List of Supported Schools SY 11-12
-The Office of Education Performance Audits list of Schools Receiving Temporary
Accreditation Status
Two priority points will be added to the base score for service to one listed school, 4 points
for more than one listed school.
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Programs that provide opportunities for participants in science, technology, arts,
engineering and mathematics (STEAM) will be awarded two priority points.
Services to middle school and/or high school students will be awarded two priority points.
Services to students attending schools designated as in need of improvement under Title I
and that are submitted jointly by school districts receiving Title I funds and community-
based organizations or other public or private organizations will be awarded four priority
points. If you have received priority points under the first bullet in this section, you
will only receive two additional points for the partnership.
In determining whether an application has been “submitted jointly,” States should look for
evidence in the application that the LEA and at least one other organization collaborated in the
planning and design of the program, each have substantial roles to play in the delivery of
services, share grant resources to carry out those roles, and have significant ongoing
involvement in the management and oversight of the program. States may want to consider
what organization(s) wrote the application, what organization will be the fiscal agent, whether
there is a history of these organizations working together, and whether there is evidence in the
application of integration of the after-school program activities with the regular school day
program. Letters of endorsement are not by themselves sufficient evidence that
organizations or school districts have substantially been involved in the design of a
program. (This clarification comes from the USDOE Nonregulatory Guidance for 21st CCLC
programs.)
HOW IS THE APPLICATION FOR A 21ST CCLC GRANT PREPARED?
The following information describes eligibility, required activities, application contents and
application review criteria.
Applications must comply with the following format:
the application narrative section must not exceed 25 typed and numbered pages, (not
including appendices) using a 12-point,Times New Roman font; double line spacing and
one-inch margins;
chart format may be used in appropriate sections;
the application must be on plain white paper (one side only) held together with a binder
clip or stapled (no notebooks or coverings) and must not include unsolicited designs,
headings, appendices, news clippings or other materials; and
the application should respond to the exact sequence, outline form, headings and
information requested herein.
According to the non-regulatory guidance for 21st CCLC, a public school or other public or private
organization that is awarded a grant must provide equitable services to private school students, and
their families. In designing a program that meets this requirement, grantees must provide
comparable opportunities for the participation of both public- and private-school students in the
area served by the grant. Grantees must consult with private school officials during the design and
development of the 21st CCLC program on issues such as how the children's needs will be
identified and what services will be offered. Services and benefits provided to private school
students must be secular, neutral, and non-ideological. This communication must be verified by
completing the form that comprises Appendix D. This form MUST be completed and signed,
even if there are no private schools in your service area.
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If plagiarism is found, or brought to the attention of officials at the West Virginia Department of
Education during a grant competition, then at the discretion of the Department, the Department has
the right to remove the grant application for funding consideration.
CONTENT OF APPLICATION
To be eligible for 21st CCLC funding, a completed 21st CCLC application MUST contain all the
following sections in the sequence provided:
1. Cover Pages
The applicant must provide all contact and descriptive information requested on the two required
cover pages. These pages must be the first two sheets of the application. (see pp.15-16).
2. Application Checklist
Include a copy of the completed checklist (see page 17).
3. Project Summary and Abstract
Complete the required Project Summary and Abstract form describing the community needs being
addressed, the participants to be served, the program objectives, the activities proposed to meet the
objectives, the intended outcomes, program evaluation activities and all other requested
information. (See pp. 18-19).
4. Table of Contents
Include a table of contents with all sections and page numbers clearly identified for the application
reviewers.
5. Application Narrative
Respond to the following required application information using a maximum of 25 pages.
A. Need for Project (20 points)
Research information shared in this section must be supported by citation of the data
source. Reapplying organizations must provide no more than a one-page summary of
data /evidence in Appendix B of having met the objectives of their last 21st CCLC
grant.
Describe the needs/resources of the community, including:
results of a current assessment of local community needs and available resources (within
the last 3 years) showing the risk factors and gaps in the services that are available,
relevant needs data regarding the family members and the students to be served, including,
but not limited to:
- data on their risk of educational failure,
- local poverty rates,
- dropout rates,
- literacy rates and
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- education levels in the community.
how the applicant consulted with private school officials during the design and
development of the applications as to the needs to be addressed and the services to be
offered. If there is no private school within the applicant’s service area, this needs to be
stated by the applicant.
B. Goals and Objectives (15 points)
Develop program goals that address identified needs. One goal must address raising
academic achievement for students with a second goal addressing raising skill levels of
adults. Other goals may be added if needed. (Please consider school and district goals
when developing goals for your program.)
List the measurable objective(s) the proposed program will use to remedy the risk factors
(needs) described for the target populations. (Be sure to consider how you will evaluate the
objectives. That information must be included in the evaluation section of the application.)
Those applicants who have previously received 21st CCLC funding, MUST provide no
more than a one-page summary of data/ evidence in Appendix B documenting the
improvement of student achievement and the utilization of partner organizations to
enhance academic performance, achievement and positive youth development of
students during the previous cycle of 21st CCLC funding.
These are Federal Targets to be considered when developing program objectives.
Federal Target*
Forty-eight percent of students participating in this program will improve their
reading and language arts grades.
Forty-eight percent of students participating in this program will improve their
mathematics grades.
Seventy-five percent of students participating in this program will demonstrate
improvement in homework completion and class participation.
Seventy-five percent of students participating in this program will demonstrate
improvement in behavior.
Eighty-five percent of out-of-school time centers emphasize programming in at least
one core academic subject area.
Eighty-five percent of out-of-school time centers offer academic enrichment and
support activities related to technology.
Eighty-five percent of out-of-school time centers offer academic enrichment, support
activities, and programming to support student learning outside of core subject areas
and technology.
Federal Targets are subject to change based on federal guidelines.
C. Project Activities & Implementation (20 points)
(Identify scientifically based research that provides evidence that the programs or activities
you include in this section will help students meet state and local student academic
achievement standards)
Describe the components and related activities that your program will offer to students,
parents, families and community members.
Describe how program services in centers will be available to any participating student a
minimum of three days for high school programs and four days per week for elementary
and middle school students. All programs must begin by October 9 and meet 25 weeks per
year. A mandatory pre-site meeting with WVDE Staff, co-applicant partner (if applicable)
program director, site coordinator, community partners, principal, central office
10
administrator representing the schools of participating students needs to be held prior to the
start of the program.
Provide a detailed plan of how your program staff will collaborate with regular school day
teachers and administrators to identify areas for individualized student assistance in
academic areas as needed.
Explain how project staff will vary their approaches to help meet the individual needs of
students and improve their achievement in core academic areas to meet or exceed local and
state standards.
Include the steps you propose to ensure equitable access to, and participation by students,
program personnel, family members and other program beneficiaries with special needs.
Describe how the proposed program will provide problem-based or project-based learning
activities that support state and local learning standards and contribute to academic
performance for all students.
Describe plans for implementing optional summer programs, if desired. Programs will not
receive credit for having a summer program if sufficient funds are not included in the
budgets for years 1-3 and in the budget narrative.
Include plans to provide supper for participating students each day the program meets, as
mandated by the state superintendent of schools. A snack may be also be offered.
D. Collaboration (15 points)
Explain how the project was developed and will be carried out in active collaboration with
the schools the students attend. Those applicants who have previously received 21st
CCLC funding must describe in no more than one page in Appendix B, the
collaboration between their previously funded program and the school’s students
attended.
Describe the partnership details between a local educational agency and community-based,
faith-based, or other public or private organization(s), if you have a joint submission.
Describe the prior experience and/or capacity of the lead organization and co-applicant
partner, if applicable, to provide educational and related activities that will complement and
enhance the academic performance, achievement, and positive youth development of
students.
Attach Memoranda of Understanding or letters that clearly indicates the role, capacity,
specific contributions and in-kind value of each partnering organization. A letter from the
principal of each participating school must be included.
If you have identified a partner agency on the cover sheet, be sure to address the definition
of “submitted jointly” found in the competitive priorities section of the application.
E. Facility Plan (10 points)
Describe how the environment will be safe, welcoming, stimulate curiosity and learning
and provide space to exhibit students’ work and projects.
Tell how the program will ensure that the students will travel safely to and from the 21st
CCLC and home from school–based and/or off- site programs. State the number of buses
needed to adequately serve the target participants, based on data provided by the county
board of education and/or principal.
Tell how the emergency exit plan and emergency readiness plan will be communicated to
the staff, students and parents.
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F. Program Personnel (15 points)
Describe procedures for managing the program.
Use a chart to describe the staff structure (roles and responsibilities). Include position
descriptions for key community and school staff. Due to hiring requirements and personnel
procedures, it is not necessary to name in the application a specific person to serve as the
program director. However, position descriptions for the personnel you intend to employ
with the 21st CCLC funding should be included.
Staffing is to be at a level that assures participant safety, as well as the highest quality of
program delivery based on the type of activity, programmatic level and number of
participants. Suggested guidelines, such as those from West Virginia Department of Health
and Human Resources, state:
A center shall group children and consider their ages when determining the staff: child ratio
as follows:
9.2.a. For programs that operate with Pre-K children, the program shall ensure that:
9.2.a.1. A 1:12 staff to child ratio is maintained; and
9.2.a.2. Group sizes are limited to 24 for any group that mixes older children
with a pre-k child.
9.2.b. For programs that operate with school age children only, the program shall
ensure that:
9.2.b.1. A 1:16 staff to child ratio is maintained;
9.2.b.2. The group size is determined by the activity and is limited to
facilitate staff/child interaction and safe, constructive participation by
children; and
9.2.c. During water activity such as swimming, canoeing, and fishing the staff: child
ratio is maintained at 1:8 for groups of school age children and is maintained at 1:4
for any group with a Pre-k child.
9.3. Groups of children must be distinct with staff persons knowing to which group
they are assigned.
9.4. Staff: child ratio and group size are always maintained based on the age of the
youngest child in the group.
Describe plans and budget for on-going staff training for the program. Expenses may
include payment of staff for time to plan and attend the training.
Describe how qualified volunteers will be used to support proposed activities.
Describe plans to ensure that at least one full-time staff member is certified in both CPR
and first aid (within one month of employment).
All out-of-school-time staff and regular volunteers must have passed an approved
background check prior to working in the program.
The Program Director must allocate a minimum of 10 hours per week to carry out grant
responsibilities.
G. Reasonable Cost for Program (5 points)
Describe how the budget is reasonable in relation to the number of persons to be served,
services to be provided and anticipated results and benefits. The budget and budget
narrative will be judged against the scope of the program and its anticipated benefits.
Explain how the program will ensure that funds will not be used to supplant federal, state,
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local or non-federal funds.
Applicants that choose to establish a fee structure must provide a narrative that explains the
fee structure and how you will assure that income and or ability to pay will not deter
families from enrolling their children in the program. Additionally, describe how the funds
will be administered and managed. Anticipated income from collection of fees should be
reported in the budget as an additional source of revenue.
H. Sustainability (10 points)
Since grant funding is intended as an incentive to promote the long-range establishment of
out-of-school-time community programs, the application must include the following:
A reasonable plan for sustaining the community learning center(s) after grant funding ends.
A description of how you will leverage other sources of funding to supplement the grant
award and to support services.
A description of how you will coordinate with other federal, state and local programs with
compatible/complimentary services (i.e. Title I, Adult Basic Education, and Supplemental
Education Services, etc.)
Beginning with this subgrantee cohort, if reapplication is made for the same sites included
in this grant in five years (or if 50% or more of the sites remain the same), the maximum
funding would be figured at 70% of the year one of the previous grant award. However, at
no time may a grant be awarded for less than $50,000.
I. Parent, Family and Community Involvement (15 points)
Describe the activities that will target parents, families of students who will receive
services from the program and community members. These activities MUST be aimed at
improving the skills of adults or at supporting the connection between parents and their
children’s learning needs.
Describe initiatives that will involve parents in their children’s learning, either at home, at
programs sponsored by the center, or elsewhere.
Describe how students, parents and community members will be involved in planning,
implementation of services, program evaluation and decision-making in the program
Explain how your program will disseminate information about the center(s) to the
community in a manner that is understandable and accessible.
J. Program Evaluation (15 points)
Indicate, in chart format: the goals and related measurable objective(s), the data to be
collected to track progress toward the objective(s), the data collection tool, the evaluation
timeline and the staff position(s) responsible for the data collection and analysis.
OR
Instead of the chart described above, a logic model that describes the program inputs,
activities, and both short-term and long-term goals, as well as the evaluation indicators and
data sources may be used.
Explain how the staff will collaborate with regular school day teachers to assess and
measure student needs and progress.
Indicate program participation in mandated federal, state and local evaluation processes
and procedures.
Program grantees will be required to complete an Annual Performance Report (APR)
indicating locally collected data such as: number of hours of programming; enrollment per
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site; achievement and grade data; regularly participating students; etc.
Grantees will also be responsible for administering an annual Teacher Survey to the regular
school-day teachers of regular attendees of the program. The teacher surveys will be
provided by the West Virginia Department of Education’s statewide evaluator or agent to
all grantees; distributing and collecting the surveys is the responsibility of the grantees.
Data will be reported on the APR. Summaries of survey results will be provided to
grantees, and grantees are encouraged to use these data in their local evaluations.
The project director from each program must also participate in an annual survey. This
survey focuses on the professional development needs of project staff, collaboration
between the project and other organizations, and successes and challenges faced by the
project.
Grantees will also be responsible for the completion of the annual WVDE Monitoring
Tool. This entails a visit by the WVDE Teacher/Instructional Coach and completion of the
WVDE Monitoring Tool. The WVDE Monitoring Tool will assure compliance with federal
and state regulations and improve program quality. 21st CCLC Teacher/Instructional
Coaches, employed by the West Virginia Department of Education, will conduct
monitoring visits and complete the monitoring tool for all programs.
Explain how the results of the evaluation must be used to: (1) improve and strengthen the
program, (2) refine the performance measures and (3) assess effectiveness of activities.
Results must also be shared with WVDE and made available to the public upon request.
Indicate program participation in a continuous improvement process annually that
examines: community and family involvement, programming, staffing and training,
finance, research, evaluation and knowledge; and policy and advocacy. Costs related to this
process should be considered when creating your program budget. A suggested cost would
be approximately $1,500.
Indicate participation in the quarterly collection of data by the WVDE to assure compliance
of grantees.
Awarded subgrantees will be held to the following standards, unless a waiver has been
approved by the state office based on extenuating circumstances.
Attendance – Based on 21st CCLC student registration, sites will have at least 70% of
enrolled students attending a minimum of 20 days and at least 50% attending a minimum of
30 days.
Goal/objective attainment—Programs will have met, or made significant progress toward,
goal attainment. In year one, when programs are being established, progress will be made
toward meeting objectives as stated in the grant application; in year two and three at least
50 percent of stated goals/objectives will be met; and in years four and five all goals and
objectives will be met.
Grant program implementation—Subgrantees will implement the program as described
in the approved or revised application.
Adequate, qualified staffing—Staffing is to be at a level that assures participant safety, as
well as the highest quality of program delivery based on the type of activity, programmatic
level and number of participants. (suggested guidelines in Program Personnel section)
Program management—Staff is organized by clearly defined roles and responsibilities
that are adequate to carry out the program successfully. Staff members and individuals or
entities providing goods or services are selected based on prior experience, qualifications
and, where applicable, specialized training and/or certification. Staff have received training
in regard to their responsibilities and understand their role in the overall program.
6. Budget (5 points)
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Complete a WVDE Budget Form (see p.20) for each of the first three years of the project.
Applicants must describe a multi-year project, but provide a formal budget only for the
first 12 months. (Funded programs reporting successful implementation will be asked to
provide continuation applications and budgets for years four and five if federal funding
continues. Year four funding will be, at maximum, 80% of the year one amount. Year five
will be, at maximum, 70% of the year one amount.)
Support from other sources that will also be used to fund the proposal, including other
revenues and in-kind donations, must be documented.
Applicants must also provide a budget for each partner contract exceeding $5,000.
(Include line items in the budget for background checks for out-of-school time staff and
regular volunteers.)
The budget must include funding for the following required professional development
opportunities at a minimum:
1. The program director to attend two WVDE-sponsored 21st CCLC meetings annually
(Registration cost is approximately $250 per person plus travel, food and lodging).
2. The program director to attend a national conference providing training on effective
before school, after school and summer school programs. Examples include:
Foundations, Inc., The National Community Education Association, BOOST or the Us
Department of Education 21st CCLC Summer Institute. (Registration cost is
approximately $400 per team plus travel, food and lodging.)
Note: grant funds cannot be used to purchase food, facilities or vehicles, or to support
construction.
Federal regulations that apply to the 21st CCLC program are: the U.S Education Department
General Administrative Regulations (EDGAR) in 34 CFR Parts 75, 77, 79, 80, 81, 82, 85, and 86,
and (b) 34 CFR Part 299. The EDGAR regulations can be found on the Department’s website:
http://www.ed.gov/about/offices/list/index.html?src+mr.
7. Budget Narrative (5 points--see sample p. 21).
Provide a detailed budget narrative for the first year that clearly explains:
the mathematical basis for estimating the costs of professional personnel salaries, benefits,
project staff travel, student transportation, materials and supplies, consultants and
subcontracts, indirect costs and other project expenditures; (Be sure to name each staff
position and provide the formula for rate of pay and the duration of services.)
required funding for parent educational opportunities
how the major cost items relate to the proposed activities and
a detailed description explaining in-kind support and/or funding/resources provided by co-
applicant partners (if applicable) and other collaborating partners in the project.
8. Assurances Forms (see pp. 22-29)
Attach the properly signed and completed assurances forms.
9. Appendices
Attach only the following Appendices:
Appendix A: a REQUIRED list of collaborating partners with contact names, addresses,
year-round telephone numbers, fax numbers and e-mail addresses; and a memorandum of
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understanding or partner letter that clearly documents the role and contribution of the
partner, as well as the in-kind value if applicable (not a generic letter of support)
Appendix B: documentation of previous grant success, as noted in the applicable sections
of grant directions (REQUIRED of previous applicants)
Appendix C: a summary of any evaluation studies, reports, or research that documents the
effectiveness or success of the co-applicant partner (if applicable) and collaborating
partners and of the activities and services proposed in the narrative section of the
application (OPTIONAL)
Appendix D: REQUIRED form to verify consultation with private school personnel
Appendix E: REQUIRED form to verify sharing with the community
Appendix F: evidence of planning application with grant co-applicant partner
(REQUIRED if submitting jointly)
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COVER PAGES
WVDE 21st Century Community Learning Centers Grant Application
School Years 2012-2017
Local Project Title:
Lead Agency
Contact Person:
Phone #: Fax #: Email:
Address:
Fiscal Agency
Contact Person:
Phone # Fax #: Email:
Address:
Co-Applicant Partner Agency*:
Contact Person:
Phone #: Fax #: Email:
Address:
*Optional-This is a competitive priority as defined in application section, “What are
the Competitive Priorities?”
Other Collaborating Partnerships
Number of collaborating partners actively involved in the project
Schools Community-Based Organizations ___Faith-Based Organizations
___Community/business ___Other (list)
School District(s) ________________________________________________________
17
Schools Served
Number of sites ________________
Funds Requested
Estimated number of students to be served:______ Proposed cost per student:________
FEIN Number (Federal Employees Identification Number)
West Virginia Vendor Number
Proposed Project Dates 7-1-12 6-30-17
start date end date
Matching (local) funds: $_________________
In-kind $ Cash $ Other (list)
Have you previously received 21st Century Community Learning Center funding from the
West Virginia Department of Education? Yes____ No _____
Date: ____________________
Agency Head’s/Superintendent’s Signature*
*Signature indicates that applicant agrees to all conditions in the proposal.
18
APPLICATION CHECKLIST FORM
One original, four hard copies and an electronic copy of the application must be received by
3:00 p.m., Friday, April 27, 2012, at the office of Dr. Marsha Bailes, Assistant Director,
Office of School Improvement, West Virginia Department of Education, Building 6, Room 617,
1900 Kanawha Boulevard, East, Charleston, WV 25305.
Five points will be deducted from the score of the application if the sections below are not
addressed in the order listed. (Check each of the following items as they are completed.)
1.) Cover Pages, fully completed and signed by an authorized official.
2.) Expansion Grant Page, if applicable
3.) Application Checklist, completed
4.) Program Summary and Abstract
5.) Table of Contents
6.) Program Narrative
7.) Budget
8.) Budget Narrative
9.) The required Assurances, Certifications, and Disclosure forms (must be signed by an
authorized official).
Non-Construction Programs (Form OMB 424B)
The certification regarding lobbying; debarment, suspension and other responsibility
matters and
Drug-free workplace requirements (Form ED-80-0013)
10.) The Appendices
11.) Electronic copy has been emailed to mcbailes@access.k12.wv.us
19
WV 21ST CCLC PROJECT SUMMARY AND ABSTRACT FORM
Student Populations to be Served (indicate number of schools in blank)
___ Elementary Schools ___ Middle Schools ___ High Schools ___ Title I schools
___ Combined List of Supported Schools ___ OEPA Temporary Accreditation
Co-applicant Partner(s) and Collaborating Organizations (indicate number in blank)
___ National Organizations (e.g., Boys & Girl Clubs, ___ County or Municipal Agencies (e.g.,
YMCA/YWCA, Big Brothers/Big Sisters) police, Parks & Recreation, Social
___ Community-Based Organizations (local non- Services)
profits or foundations) ___ Colleges or Universities
___ Libraries or Museums ___ Faith-Based Organizations
___ Businesses ___ Hospitals/Clinics/Health Providers
___ other __________________________
Services to be Provided (check all that apply)
Reading or Literacy Physical Education Health, Nutrition
Mathematics Technology, Video or Media Youth Development
Science Service Learning Services for Adults
Art, Music, Dance, Cultural Activities, Social Homework Help
Theater Studies Tutoring
Other ___________
Times of Operation
Before school After school Summer Weekend
20
Page 2 -- Project Summary and Abstract
Mon Tues Wed Thur Fri Sat
Mon Tues Wed Thur Fri Sat
Mon Tues Wed Thur Fri Sat
Mon Tues Wed Thur Fri Sat
Mon Tue Wed Thur Fri Sat
*Start date of each site is no later than Monday, October 9th.
Estimated number to be served does not refer to the total school population but to the estimated students likely to
participate. Explain how that number of student and adult and/or family participants was determined:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Abstract. In the space below, briefly describe your program’s goals, services, activities, and planned participants.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
21
WVDE – 21st CCLC GRANT BUDGET FORM
Complete a form for the 1st, 2nd, and 3rd years of your program
County Agency/School _____________
Financial Contact Person _______________________________________________
Complete Street Address _______________________________________________
Phone # Fax # E-mail __________________________
Federal Funding (Line Items) Funds Requested
Administrative
Salary (Program Director, Secretary, Administrative Assistant) $ _______
Fringe Benefits $ _______
Subtotal $ _______
Programmatic
Salary (Tutors, Site Coordinators) $ _______
Fringe Benefits $ _______
Supplies/consumables $ _______
Transportation $ _______
Travel reimbursement (meetings) $ _______
Training $ _______
Evaluation (recommended budget of at least $1,500) $ _______
Rental $ _______
Other (describe) __________________________________________ $ _______
Subtotal $ _______
Indirect cost (school board rate or 6% maximum) $ _______
TOTAL FEDERAL FUNDING REQUESTED $ _______
Local Funding & Contributions (Line Items) Matching Funds
Salary (administrative) $ _______
Fringe Benefits $ _______
Salary (staff) $ _______
Supplies/consumables $ _______
Transportation $ _______
Travel reimbursement (meetings) $ _______
Training $ _______
Evaluation $ _______
Rental $ _______
Other (describe) _____________________________________________ $ _______
LOCAL FUNDING CONTRIBUTIONS TOTAL $ _______
TOTAL PROGRAM BUDGET (FEDERAL + LOCAL) $ _______
_________________________________________________________ Date _____
Superintendent’s or Agency Director’s Signature
**************************************************************************************
STATE USE ONLY
Federal Funds Approved $ Program Code _______________
Account # 8712-096 Revenue Code 04511 FIMS ID _________
Date_______________
State Agency’s Signature
Last Updated: July 27, 2012
22
EXAMPLE BUDGET NARRATIVE ITEMS
Your proposal must have a budget narrative explaining each line item on your
2012-2013 Budget Form. List each of your requested budget items, whether it is
federally funded or a local contribution, the purpose, and the math used to estimate
it.
Budget Item Funding Examples of Funding Purposes & Calculations
Salary Federal 1 Project Director x $2,500/month x 12 months = $30,000 + fringe benefits =$
Federal 1 Tutor x $20/hour x 6 hours/week X 25 weeks = $3,000 + fringe =$
Federal 2 VISTA workers x $10,000/year = $20,000
Federal 1 Karate teacher x $20/hour x 2 hours/week x 8 weeks =$320
Local 1 Dentist x $300/day x12 days = $3,600
Local 1 Part-time secretary x $15/hour X 10 hours x 25 weeks = $3,750
Supplies Federal 10 Basketballs x $10.00/ball = $100
Federal 10 Modeling clay x 20.00/box = $200
Federal 10 Magnifying glasses x $8/per = $80
Local 25 Watercolor paint x $2/set = $50
Transportation Federal 1 Bus driver x$20/hour x 3 hours/day x 4 days/week x 25 weeks + fringe =
Local 1 Bus driver (field trips) x $20/hour x 12 hours + fringe =$
Travel Federal 2 staff members X 2 WVDE training registration fees x $250/training = $1,000
Federal 2 staff members X 100 miles x $.50/mile = $100
Evaluation Federal One local continuous improvement evaluation = $1,500
Note: It is your responsibility to maintain documentation for 5 years to support expenditures.
Last Updated: July 27, 2012
23
ASSURANCE FORMS
Lobbying, Debarment, Suspension, etc. form ED 80-0013
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE
REQUIREMENTS
Applicants should refer to the regulations cited below to determine the certification to which they
are required to attest. Applicants should also review the instructions for certification included in
the regulations before completing this form. Signature of this form provides for compliance with
certification requirements under 34 CFR Part 82, "New Restrictions on Lobbying," and 34 CFR
Part 85, "Government-wide Debarment and Suspension (Nonprocurement) and Government-
wide Requirements for Drug-Free Workplace (Grants)." The certifications shall be treated as a
material representation of fact upon which reliance will be placed when the Department of
Education determines to award the covered transaction, grant, or cooperative agreement.
1. LOBBYING
As required by Section 1352, Title 31 of the U.S. Code, and implemented at 34 CFR Part 82, for
persons entering into a grant or cooperative agreement over $100,000, as defined at 34 CFR Part
82, Sections 82.105 and 82.110, the applicant certifies that:
(a) No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee of
any agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the making of any federal grant, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of
any federal grant or cooperative agreement;
(b) If any funds other than federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this federal grant or cooperative agreement, the undersigned shall
complete and submit Standard Form - LLL, "Disclosure Form to Report Lobbying," in
accordance with its instructions;
(c) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subgrants, contracts under grants and
cooperative agreements, and subcontracts) and that all subrecipients shall certify and disclose
accordingly.
2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS
As required by Executive Order 12549, Debarment and Suspension, and implemented at 34 CFR
Part 85, for prospective participants in primary covered transactions, as defined at 34 CFR Part
85, Sections 85.105 and 85.110--
A. The applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any Federal department or agency;
Last Updated: July 27, 2012
24
(b) Have not within a three-year period preceding this application been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (federal, state, or local)
transaction or contract under a public transaction; violation of federal or state antitrust statutes or
commission of embezzlement, theft, forgery, bribery, falsification or destruction of records,
making false statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental
entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph
(2)(b) of this certification; and
(d) Have not within a three-year period preceding this application had one or more public
transaction (federal, state, or local) terminated for cause or default; and
B. Where the applicant is unable to certify to any of the statements in this certification, he or she
shall attach an explanation to this application.
3. DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS)
As required by the Drug-Free Workplace Act of 1988, and implemented at 34 CFR Part 85,
Subpart F, for grantees, as defined at 34 CFR Part 85, Sections 85.605 and 85.610 -
A. The applicant certifies that it will or will continue to provide a drug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace
and specifying the actions that will be taken against employees for violation of such prohibition;
(b) Establishing an on-going drug-free awareness program to inform employees about:
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the
workplace;
(c) Making it a requirement that each employee to be engaged in the performance of the grant be
given a copy of the statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of
employment under the grant, the employee will:
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug
statute occurring in the workplace no later than five calendar days after such conviction;
(e) Notifying the agency, in writing, within 10 calendar days after receiving notice under
subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction.
Employers of convicted employees must provide notice, including position title, to: Director,
Grants Policy and Oversight Staff, U.S. Department of Education, 400 Maryland Avenue, S.W.
(Room 3652, GSA Regional Office Building No. 3), Washington, DC 20202-4248. Notice shall
include the identification number(s) of each affected grant;
Last Updated: July 27, 2012
25
(f) Taking one of the following actions, within 30 calendar days of receiving notice under
subparagraph (d)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including
termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State, or local health, law
enforcement, or other appropriate agency;
(g) Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (a), (b), (c), (d), (e), and (f).
B. The grantee may insert below the site(s) for the performance of work done in connection
with the specific grant: Place of Performance (street address. city, county, state, zip code)
Check if there are workplaces on file that are not identified here.
DRUG-FREE WORKPLACE (GRANTEES WHO ARE INDIVIDUALS)
As required by the Drug-Free Workplace Act of 1988, and implemented at 34 CFR Part 85,
Subpart F, for grantees, as defined at 34 CFR Part 85, Sections 85.605 and 85.610-
A. As a condition of the grant, I certify that I will not engage in the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance in conducting any
activity with the grant; and
B. If convicted of a criminal drug offense resulting from a violation occurring during the
conduct of any grant activity, I will report the conviction, in writing, within 10 calendar days
of the conviction, to: Director, Grants Policy and Oversight Staff, Department of Education,
400 Maryland Avenue, S.W. (Room 3652, GSA Regional Office Building No. 3),
Washington, DC 20202-4248. Notice shall include the identification number(s) of each
affected grant.
As the duly authorized representative of the applicant, I hereby certify that the applicant will
comply with the above certifications.
NAME OF APPLICANT:
PROJECT NAME:
PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE:
SIGNATURE: DATE:
ED 80-0013 10/08
Last Updated: July 27, 2012
26
ASSURANCES - 2
Non-Construction form SF 424B
OMB Approval No. 0348-0040
ASSURANCES - NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per
response, including time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information.
Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of Management and
Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503
Note: Certain of these assurances may not be applicable to your project or program. If you have
questions, please contact the awarding agency. Further, certain federal awarding agencies
may require applicants to certify to additional assurances. If such is the case, you will be
notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for federal assistance, and the institutional, managerial and
financial capability (including funds sufficient to pay the non-federal share of project cost) to
ensure proper planning, management, and completion of the project described in this
application.
2. Will give the awarding agency, the Comptroller General of the United States, and if
appropriate, the state, through any authorized representative, access to and the right to
examine all records, books, papers, or documents related to the award; and will establish a
proper accounting system in accordance with generally accepted accounting standards or
agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that
constitutes or presents the appearance of personal or organizational conflict of interest, or
personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval
of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 004728-4763)
relating to prescribed standards for merit systems for programs funded under one of the 19
statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all federal statutes relating to nondiscrimination. These include but are not
limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits
discrimination on the basis of race, color or national origin; (b) Title IX of the Education
-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of
794), which prohibits discrimination on the basis of
-6107),
which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment
Last Updated: July 27, 2012
27
Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug
abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the
basis of alcoh
-3 and 290 ee 3), as amended, relating to confidentiality of
alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42
financing of housing; (i) any other nondiscrimination provisions in the specific statute(s)
under which application for federal assistance is being made; and (j) the requirements of any
other nondiscrimination statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the
uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-
646) which provide for fair and equitable treatment of persons displaced or whose property is
acquired as a result of federal or federally assisted programs. These requirements apply to all
interests in real property acquired for project purposes regardless of federal participation in
purchases.
8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. 001501-1508 and
7324-7328), which limit the political activities of employees whose principal employment
activities are funded in whole or in part with federal funds.
9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. 00276a to
276a-
-333), regarding labor standards for
federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of
the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special
flood hazard area to participate in the program and to purchase flood insurance if the total
cost of insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the
following: (a) institution of environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b)
notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant
to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988;
(e) assurance of project consistency with the approved state management program developed
conformity of Federal actions to State (Clear Air) Implementation Plans under Section
of underground sources of drinking water under the Safe Drinking Water Act of 1974, as
amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered
Species Act of 1973, as amended, (P.L. 93-205).
12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 001721 et seq.) related
to protecting components or potential components of the national wild and scenic rivers
system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National
Historic Preservation Act of 1966, as amended (16 U.S.C.
Last Updated: July 27, 2012
28
and protection of historic properties), and the Archaeological and Historic Preservation Act
-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in
research, development, and related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7
ooded
animals held for research, teaching, or other activities supported by this award of assistance.
16. Will comply with the Lead-
seq.), which prohibits the use of lead-based paint in construction or rehabilitation of
residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with
the Single Audit Act Amendments of 1996 and OMB Circular No. A-
Local Governments, and Non-P
18. Will comply with all applicable requirements of all other federal laws, executive orders,
regulations and policies governing this program.
NAME OF APPLICANT:
PROJECT NAME:
SIGNATURE:
DATE:
Standard Form 424B (Rev. 7-97) Back
Last Updated: July 27, 2012
29
ASSURANCES - 3
GEPA Equitable Access form 1890-0007
OMB Control No. 1890-0007 (Exp. 09/30/2004)
NOTICE TO ALL APPLICANTS
The purpose of this enclosure is to inform you about a new provision in the Department of
Education's General Education Provisions Act (GEPA) that applies to applicants for new grant
awards under Department programs. This provision is Section 427 of GEPA, enacted as part of
the Improving America's Schools Act of 1994 (Public Law (P.L.) 103-382).
To Whom Does This Provision Apply?
Section 427 of GEPA affects applicants for new grant awards under this program. ALL
APPLICANTS FOR NEW AWARDS MUST INCLUDE INFORMATION IN THEIR
APPLICATIONS TO ADDRESS THIS NEW PROVISION IN ORDER TO RECEIVE
FUNDING UNDER THIS PROGRAM.
(If this program is a state-formula grant program, a state needs to provide this description only
for projects or activities that it carries out with funds reserved for state-level uses. In addition,
local school districts or other eligible applicants that apply to the state for funding need to
provide this description in their applications to the state for funding. The state would be
responsible for ensuring that the school district or other local entity has submitted a sufficient
section 427 statement as described below.)
What Does This Provision Require?
Section 427 requires each applicant for funds (other than an individual person) to include in its
application a description of the steps the applicant proposes to take to ensure equitable access
to, and participation in, its federally-assisted program for students, teachers, and other
program beneficiaries with special needs. This provision allows applicants discretion in
developing the required description. The statute highlights six types of barriers that can impede
equitable access or participation: gender, race, national origin, color, disability, or age. Based on
local circumstances, you should determine whether these or other barriers may prevent your
students, teachers, etc. from such access or participation in, the federally-funded project or
activity. The description in your application of steps to be taken to overcome these barriers need
not be lengthy; you may provide a clear and succinct description of how you plan to address
those barriers that are applicable to your circumstances. In addition, the information may be
provided in a single narrative, or, if appropriate, may be discussed in connection with related
topics in the application.
Section 427 is not intended to duplicate the requirements of civil rights statutes, but rather to
ensure that, in designing their projects, applicants for federal funds address equity concerns that
may affect the ability of certain potential beneficiaries to fully participate in the project and to
achieve to high standards. Consistent with program requirements and its approved application,
an applicant may use the federal funds awarded to it to eliminate barriers it identifies.
What are Examples of How an Applicant Might Satisfy the Requirement of This
Provision?
The following examples may help illustrate how an applicant may comply with Section 427.
Last Updated: July 27, 2012
30
(1) An applicant that proposes to carry out an adult literacy project serving, among others,
adults with limited English proficiency, might describe in its application how it intends to
distribute a brochure about the proposed project to such potential participants in their native
language.
(2) An applicant that proposes to develop instructional materials for classroom use might
describe how it will make the materials available on audio tape or in Braille for students who
are blind.
(3) An applicant that proposes to carry out a model science program for secondary students
and is concerned that girls may be less likely than boys to enroll in the course, might indicate
how it intends to conduct "outreach" efforts to girls, to encourage their enrollment.
We recognize that many applicants may already be implementing effective steps to ensure equity
of access and participation in their grant programs, and we appreciate your cooperation in
responding to the requirements of this provision.
Estimated Burden Statement for GEPA Requirements
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless such collection displays a valid OMB control number. The valid
OMB control number for this information collection is 1890-0007. The time required to
complete this information collection is estimated to average 1.5 hours per response, including the
time to review instructions, search existing data resources, gather the data needed, and complete
and review the information collection. If you have any comments concerning the accuracy of
the time estimate(s) or suggestions for improving this form, please write to: Director, Grants
Policy and Oversight Staff, U.S. Department of Education, 400 Maryland Avenue, SW (Room
3652, GSA Regional Office Building No. 3), Washington, DC 20202-4248.
NAME OF APPLICANT PROJECT NAME
PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
SIGNATURE DATE
Last Updated: July 27, 2012
31
PRINCIPLES OF EFFECTIVENESS
(1) IN GENERAL- For a program or activity developed pursuant to this part to
meet the principles of effectiveness, such program or activity shall —
(A) be based upon an assessment of objective data regarding the need for
before and after school programs (including during summer recess
periods) and activities in the schools and communities;
(B) be based upon an established set of performance measures aimed at
ensuring the availability of high quality academic enrichment
opportunities; and
(C) if appropriate, be based upon scientifically based research that
provides evidence that the program or activity will help students meet
the State and local student academic achievement standards.
Last Updated: July 27, 2012
