CARES Plus Phase IE xpenditure Reporting Forms Package Final by 4hRKVe0C

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                                                                                                  CARES Plus
                                                                       Phase I — Planning and Development Expenditures by Allowable Activity
                                       Activity A: Initiating or Building on Current Outreach Activities to Reach the Population Targeted under Program Requirements
                                                                                        February 16, 2011 - June 30, 2011
                                                                                          DUE: August 1, 2011

     County                                    Select County                                                                                                                                           County Group           C
     Name of Lead Agency                                                                                                                                                                               Allocation        $75,000.00
     Address 1
     Address 2
     City, State Zip Code

                                                                Contractual
                                                                                                                                                 Operating Costs
                                                                 Service                        Staff                                                                                                                      Total
                              Activity Description                                Personnel                                                                                                              Evaluation
                                                                                               Benefits                                             Meeting                                                             Expenditures
                                                                 Yes or No                                 Materials    Supplies      Printing                  I/T Support   Equipment     Other
                                                                                                                                                   Space/AV
1                                                                                                                                                                                                                                 $0.00


2                                                                                                                                                                                                                                 $0.00


3                                                                                                                                                                                                                                 $0.00


4                                                                                                                                                                                                                                 $0.00


5                                                                                                                                                                                                                                 $0.00


6                                                                                                                                                                                                                                 $0.00


7                                                                                                                                                                                                                                 $0.00


8                                                                                                                                                                                                                                 $0.00


9                                                                                                                                                                                                                                 $0.00


10                                                                                                                                                                                                                                $0.00

                                                               Activity A Total        $0.00       $0.00        $0.00         $0.00        $0.00        $0.00         $0.00         $0.00      $0.00            $0.00             $0.00

       First 5 California Use Only
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                                                                                  CARES Plus
                                                       Phase I — Planning and Development Expenditures by Allowable Activity
        Activity B: Developing and/or Renegotiating Memorandums of Understanding and/or Contracts with Proposed Collaborative Partners Serving CARES Plus Participants
                                                                        February 16, 2011 - June 30, 2011

     County                                    Select County                                                                                                                                           County Group           C
     Name of Lead Agency                                                                                                                                                                               Allocation        $75,000.00
     Address 1
     Address 2
     City, State Zip Code

                                                                Contractual
                                                                                                                                                 Operating Costs
                                                                 Service                        Staff                                                                                                                      Total
                              Activity Description                                Personnel                                                                                                              Evaluation
                                                                                               Benefits                                             Meeting                                                             Expenditures
                                                                 Yes or No                                 Materials    Supplies      Printing                  I/T Support   Equipment     Other
                                                                                                                                                   Space/AV
1                                                                                                                                                                                                                                 $0.00


2                                                                                                                                                                                                                                 $0.00


3                                                                                                                                                                                                                                 $0.00


4                                                                                                                                                                                                                                 $0.00


5                                                                                                                                                                                                                                 $0.00


6                                                                                                                                                                                                                                 $0.00


7                                                                                                                                                                                                                                 $0.00


8                                                                                                                                                                                                                                 $0.00


9                                                                                                                                                                                                                                 $0.00


10                                                                                                                                                                                                                                $0.00

                                                               Activity B Total        $0.00       $0.00        $0.00         $0.00        $0.00        $0.00         $0.00         $0.00      $0.00            $0.00             $0.00

       First 5 California Use Only
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                                                                                        CARES Plus
                                                             Phase I — Planning and Development Expenditures by Allowable Activity
                      Activity C: Developing and/or Enhancing Curriculum Alignment and Articulation Agreements with Two- and Four-Year Institutions of Higher Education
                                                                              February 16, 2011 - June 30, 2011

     County                                    Select County                                                                                                                                           County Group           C
     Name of Lead Agency                                                                                                                                                                               Allocation        $75,000.00
     Address 1
     Address 2
     City, State Zip Code

                                                                Contractual
                                                                                                                                                 Operating Costs
                                                                 Service                        Staff                                                                                                                      Total
                              Activity Description                                Personnel                                                                                                              Evaluation
                                                                                               Benefits                                             Meeting                                                             Expenditures
                                                                 Yes or No                                 Materials    Supplies      Printing                  I/T Support   Equipment     Other
                                                                                                                                                   Space/AV
1                                                                                                                                                                                                                                 $0.00


2                                                                                                                                                                                                                                 $0.00


3                                                                                                                                                                                                                                 $0.00


4                                                                                                                                                                                                                                 $0.00


5                                                                                                                                                                                                                                 $0.00


6                                                                                                                                                                                                                                 $0.00


7                                                                                                                                                                                                                                 $0.00


8                                                                                                                                                                                                                                 $0.00


9                                                                                                                                                                                                                                 $0.00


10                                                                                                                                                                                                                                $0.00

                                                               Activity C Total        $0.00       $0.00        $0.00         $0.00        $0.00        $0.00         $0.00         $0.00      $0.00            $0.00             $0.00

       First 5 California Use Only
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                                                                                                    CARES Plus
                                                                       Phase I — Planning and Development Expenditures by Allowable Activity
                                                         Activity D: Recruiting and Training of Staff to Implement the CARES Plus Program Requirements
                                                                                         February 16, 2011 - June 30, 2011

     County                                    Select County                                                                                                                                              County Group           C
     Name of Lead Agency                                                                                                                                                                                  Allocation        $75,000.00
     Address 1
     Address 2
     City, State Zip Code

                                                                   Contractual
                                                                                                                                                    Operating Costs
                                                                    Service                        Staff                                                                                                                      Total
                              Activity Description                                   Personnel                                                                                                              Evaluation
                                                                                                  Benefits                                             Meeting                                                             Expenditures
                                                                    Yes or No                                 Materials    Supplies      Printing                  I/T Support   Equipment     Other
                                                                                                                                                      Space/AV
1                                                                                                                                                                                                                                    $0.00


2                                                                                                                                                                                                                                    $0.00


3                                                                                                                                                                                                                                    $0.00


4                                                                                                                                                                                                                                    $0.00


5                                                                                                                                                                                                                                    $0.00


6                                                                                                                                                                                                                                    $0.00


7                                                                                                                                                                                                                                    $0.00


8                                                                                                                                                                                                                                    $0.00


9                                                                                                                                                                                                                                    $0.00


10                                                                                                                                                                                                                                   $0.00

                                                                  Activity D Total        $0.00       $0.00        $0.00         $0.00        $0.00        $0.00         $0.00         $0.00      $0.00            $0.00             $0.00

       First 5 California Use Only
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                                                                                                 CARES Plus
                                                                     Phase I — Planning and Development Expenditures by Allowable Activity
                                                                     Activity E: Purchasing Resource Materials Aligned with Component A
                                                                                       February 16, 2011 - June 30, 2011

     County                                    Select County                                                                                                                                           County Group           C
     Name of Lead Agency                                                                                                                                                                               Allocation        $75,000.00
     Address 1
     Address 2
     City, State Zip Code

                                                                Contractual
                                                                                                                                                 Operating Costs
                                                                 Service                        Staff                                                                                                                      Total
                              Activity Description                                Personnel                                                                                                              Evaluation
                                                                                               Benefits                                             Meeting                                                             Expenditures
                                                                 Yes or No                                 Materials    Supplies      Printing                  I/T Support   Equipment     Other
                                                                                                                                                   Space/AV
1                                                                                                                                                                                                                                 $0.00


2                                                                                                                                                                                                                                 $0.00


3                                                                                                                                                                                                                                 $0.00


4                                                                                                                                                                                                                                 $0.00


5                                                                                                                                                                                                                                 $0.00


6                                                                                                                                                                                                                                 $0.00


7                                                                                                                                                                                                                                 $0.00


8                                                                                                                                                                                                                                 $0.00


9                                                                                                                                                                                                                                 $0.00


10                                                                                                                                                                                                                                $0.00

                                                               Activity E Total        $0.00       $0.00        $0.00         $0.00        $0.00        $0.00         $0.00         $0.00      $0.00            $0.00             $0.00

       First 5 California Use Only
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                                                                                                    CARES Plus
                                                                        Phase I — Planning and Development Expenditures by Allowable Activity
                                                           Activity F: Aligning Local Evaluations and Data Systems to Meet the Requirements of this RFA
                                                                                          February 16, 2011 - June 30, 2011

     County                                    Select County                                                                                                                                               County Group           C
     Name of Lead Agency                                                                                                                                                                                   Allocation        $75,000.00
     Address 1
     Address 2
     City, State Zip Code

                                                                    Contractual
                                                                                                                                                     Operating Costs
                                                                     Service                        Staff                                                                                                                      Total
                              Activity Description                                    Personnel                                                                                                              Evaluation
                                                                                                   Benefits                                             Meeting                                                             Expenditures
                                                                     Yes or No                                 Materials    Supplies      Printing                  I/T Support   Equipment     Other
                                                                                                                                                       Space/AV
1                                                                                                                                                                                                                                     $0.00


2                                                                                                                                                                                                                                     $0.00


3                                                                                                                                                                                                                                     $0.00


4                                                                                                                                                                                                                                     $0.00


5                                                                                                                                                                                                                                     $0.00


6                                                                                                                                                                                                                                     $0.00


7                                                                                                                                                                                                                                     $0.00


8                                                                                                                                                                                                                                     $0.00


9                                                                                                                                                                                                                                     $0.00


10                                                                                                                                                                                                                                    $0.00

                                                                   Activity F Total        $0.00       $0.00        $0.00         $0.00        $0.00        $0.00         $0.00         $0.00      $0.00            $0.00             $0.00

       First 5 California Use Only
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                                                                                                 CARES Plus
                                                                     Phase I — Planning and Development Expenditures by Allowable Activity
                                                                             Activity G: Providing Direct Services to Participants
                                                                                       February 16, 2011 - June 30, 2011

     County                                    Select County                                                                                                                                           County Group           C
     Name of Lead Agency                                                                                                                                                                               Allocation        $75,000.00
     Address 1
     Address 2
     City, State Zip Code

                                                                Contractual
                                                                                                                                                 Operating Costs
                                                                 Service                        Staff                                                                                                                      Total
                              Activity Description                                Personnel                                                                                                              Evaluation
                                                                                               Benefits                                             Meeting                                                             Expenditures
                                                                 Yes or No                                 Materials    Supplies      Printing                  I/T Support   Equipment     Other
                                                                                                                                                   Space/AV
1                                                                                                                                                                                                                                 $0.00


2                                                                                                                                                                                                                                 $0.00


3                                                                                                                                                                                                                                 $0.00


4                                                                                                                                                                                                                                 $0.00


5                                                                                                                                                                                                                                 $0.00


6                                                                                                                                                                                                                                 $0.00


7                                                                                                                                                                                                                                 $0.00


8                                                                                                                                                                                                                                 $0.00


9                                                                                                                                                                                                                                 $0.00


10                                                                                                                                                                                                                                $0.00

                                                               Activity G Total        $0.00       $0.00        $0.00         $0.00        $0.00        $0.00         $0.00         $0.00      $0.00            $0.00             $0.00

       First 5 California Use Only
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                                                                                                                                                                CARES Plus
                                                                                                                                                   Phase I Expenditure Report




                                                              CARES Plus
                                  Phase I — Planning and Development Expenditures by Allowable Activity
                                                   Summary of Phase I Expenditures
                                                    February 16, 2011 - June 30, 2011


     County                       Select County                                                        TOTAL AMOUNT REQUESTED FOR STATE TO REIMBURSE LEAD AGENCY
     Name of Lead Agency                                                                                   CARES Plus Phase I Reimbursement                                     $0.00
     Address 1
     Address 2
     City, State Zip Code




                 Budget Category                 Activity A      Activity B       Activity C       Activity D       Activity E        Activity F      Activity G          Total
1 Personnel                                              $0.00           $0.00             $0.00            $0.00            $0.00           $0.00            $0.00              $0.00
2 Staff Benefits                                         $0.00           $0.00             $0.00            $0.00            $0.00           $0.00            $0.00              $0.00
3 Operating Costs
4      Materials                                         $0.00           $0.00             $0.00            $0.00            $0.00           $0.00            $0.00              $0.00
5      Supplies                                          $0.00           $0.00             $0.00            $0.00            $0.00           $0.00            $0.00              $0.00
6      Printing                                          $0.00           $0.00             $0.00            $0.00            $0.00           $0.00            $0.00              $0.00
7      Meeting Space/AV                                  $0.00           $0.00             $0.00            $0.00            $0.00           $0.00            $0.00              $0.00
8      I/T Support                                       $0.00           $0.00             $0.00            $0.00            $0.00           $0.00            $0.00              $0.00
9      Equipment                                         $0.00           $0.00             $0.00            $0.00            $0.00           $0.00            $0.00              $0.00
10     Other                                             $0.00           $0.00             $0.00            $0.00            $0.00           $0.00            $0.00              $0.00
11                   Operating Costs Subtotal            $0.00           $0.00             $0.00            $0.00            $0.00           $0.00            $0.00              $0.00
12 Evaluation                                            $0.00           $0.00             $0.00            $0.00            $0.00           $0.00            $0.00              $0.00
13                 Phase I Total Expenditures            $0.00           $0.00             $0.00            $0.00            $0.00           $0.00            $0.00              $0.00



         First 5 California Use
     By signing below, I certify that the information provided herein is true and accurate and complies with the provisions for reimbursement detailed in the assigned CARES Plus
     RFA and the Lead Agency's approved application. I further certify that documentation supporting these expenditures is on file, readily available for review, and will be retained
     for a period of three years after the close of the project. I also certify that the Lead Agency will fully participate in the required CARES Plus evaluation and data collection
     process administered by First 5 California and/or its designee.



     Lead Agency Executive Director or Authorized Designee



     Signature                                                                                                                       Date

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             CARES Plus
Phase I Expenditure Report
             CARES Plus
Phase I Expenditure Report
             CARES Plus
Phase I Expenditure Report
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Phase I Expenditure Report
             CARES Plus
Phase I Expenditure Report

								
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