DPI Form # by mtPjMYC


									          Community Learning Center Self-Assessment Summary
Community Learning Center site (school name):

Grantee (school district or community-based organization):

Grant project director (name): _________________________

Date completed: ___________

Participants in the self-assessment (names and titles or roles):


Use the following rating scale to select the response that best characterizes this
Community Learning Center.
1 = Completely       2 = To some degree 3 = Not at all N = Don’t know/not

A. Requirements of the CLC program
                                                     Rating                     Evidence
1. All program activities take place in a safe and            [ ] Site inspection records
   easily accessible facility.                                [ ] Other:

2. Students in the program travel safely to and               [ ] Transportation plan implementation
   from the center and home. Safe transportation              or services documents
   is not a barrier to any students.                          [ ] Other:

3. Information about the CLC is disseminated to               [ ] Dissemination examples
   the community in an understandable and                     [ ] Distribution records
   appropriate manner.                                        [ ] Other:

4. The program is carried out in active                       [ ] Records of school personnel
   collaboration with the school(s) the students              involvement
   attend.                                                    [ ] Other:
5. Academic services are clearly aligned with the             [ ] Summary of alignment of school
   school’s curriculum.                                       curriculum and CLC academic
                                                              [ ] Other:
6. The program is carried out by a partnership of             [ ] Partnership records
   the school(s) and community-based                          [ ] Other:

7. The program is combined or coordinated with        [ ] Records demonstrating
   other federal, state and local programs to make    coordination
   effective use of resources.                        [ ] Other:

8. The majority of students served attend a school    [ ] Attendance records
   with socio-economic disadvantage rate of at        [ ] Other:
   least 40%.

9. If appropriate to the plan, the program            [ ] Attendance records
   primarily serves students who attend schools       [ ] Other:
   that have been identified for improvement.

10. The program provides services to a significant    [ ] Attendance records, academic and
    portion of the students with the greatest need    behavioral records
    for academic support and youth development.       [ ] Other:

11. The program provides academic and other           [ ] Attendance records
    services to approximately 50 students who         [ ] Other:
    regularly attend (50 “regular attendees”), 30
    times per school year.

12. The program allows equitable participation of     [ ] Records of invitation to private
    students from private schools from the area       schools
    served.                                           [ ] Other:

13. The program provides remedial education           [ ] Program implementation records
    activities and academic enrichment learning       [ ] Other:
    programs, including providing assistance to
    students to allow the students to improve their
    academic achievement.

14. The program provides at least three of the        [ ] Program implementation records
    following:                                        [ ] Other:
     Mathematics and science education
     Art and music education activities;
     Entrepreneurial education programs;
     Tutoring services and mentoring
     Programs for limited English proficient
    students emphasizing language skills &
    academic achievement;
     Recreational activities, including those
         involving physical activity;

    Telecommunications and technology
   education programs;
    Expanded library service hours;
    Programs that promote parent involvement
   and family literacy;
    Programs that provide assistance to
   students who have been truant, suspended,
   expelled, to improve academic achievement;
    Drug and violence prevention programs,
   counseling programs, and character education

15. The program provides services to families of              [ ] Program implementation records
    students attending the center for literacy and            [ ] Other:
    related educational development.

16. The program is accessible to people with                  [ ] Site inspection records
    disabilities.                                             [ ] Program records of adaptations to
                                                              serve students with disabilities
                                                              [ ] Other:
17. The program is evaluated to be able to                    [ ] Evaluation plan implementation
    determine if it is reaching both process and              records
    outcome objectives.                                       [ ] Other:

18. The program evaluation results are used to                [ ] Documented application of
    refine, improve and strengthen the program,               evaluation results
    and to refine the performance measures.                   [ ] Other:

19. The evaluation results are made available to              []
    the public upon request. Public notice of the             [ ] Other:
    results is given.

20. All funds are used in a manner consistent with            [ ] Fiscal records
    the purpose of the CLC program.                           [ ] Other:

B. Promising practices

(Note, the Department has much more extensive lists of promising practices available for
grantees who wish to review for further self-assessment and program improvement.)

                                                     Rating             Evidence
1. The program provides services for at least 10              [ ] Program implementation records
   hours per week, on average, during the school              [ ] Other:

2. Parents are actively involved in planning and             []
   implementing the program.                                 [ ] Other:
3. Staff and others are fully prepared to provide            [ ] Staff evaluations
   program services.                                         [ ] Other:

4. Ongoing professional development is provided              [ ] Training records and plan
   for all involved in program implementation.               [ ] Other:

5. The program utilizes research-based programs.             [ ] Program records
                                                             [ ] Other:
6. The program is an established part of the                 [ ] School Improvement plan
   school improvement plan.                                  [ ] Other:

7. Strategies to sustain the program after grant
   funding ends are in place.

C. Program Results
                                                    Rating             Evidence
1. Program evaluations provide clear evidence of             [ ] Program evaluation results
   positive impact on academic achievement for a             including Annual Performance Report
   significant portion of regular attendees.                 [ ] Other:
2. Program evaluations provide clear evidence of             [ ] Program evaluation results
   positive impact on behavior or other                      including Annual Performance Report
   measurable youth development outcomes for a               [ ] Other:
   significant portion of regular attendees.
3. Objectives and performance measures are                   [ ] Program evaluation results
   being met.                                                including Annual Performance Report
                                                             [ ] Other:

Comments on the assessment results: (attach additional page)


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