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20120829 fy13 upk opencompetitive checklist by US8mod


									                          Massachusetts Department of Early Education and Care
                        FY 2013 Universal Pre-Kindergarten Open Competitive Grant
                                             Fund Code 511-B
                                 Application Request for Response (RFR)

                            Checklist for Required Grant Application Documents

                                             (Agency Name)
                                       Program Name If Applicable

Instructions: Indicate by marking all line items have been submitted. Please use the most current forms
associated with the grant application. Assemble and submit in the order as listed below. All submitted
information will be reviewed as outlined in the general evaluation criteria. These forms are also all available
on EEC website: and Comm-PASS.

Please submit ALL documents in their original file format i.e., Word, Excel, etc…

DO NOT SUBMIT the entire application as one PDF. (You may submit the signed cover sheet as a PDF.)

Applicant use: EEC use:

                        Checklist Form (this document)
                        Signed Cover Page (authorized signatory)

Application for Program Grants Workbook Components

                        Front Page
                        Program Contacts
                        Communities Served
                        Languages Spoken
                        Fund Allocation
                        Expenditure Description
                        Budget Detail

Additional Required Application Components

                       Proposal Narrative
                       Projected Deliverables Form
                       “High Needs Children” Summary Form
                       FY 2013 Survey Monkey
                       Copy of Indirect Cost Approval Letter (if claiming Indirect Cost)
                       One signed original and three hard copies: date Submitted_______________
                       *Electronic copy: date submitted__________
* Electronic Submission Information:

                                                                                          August 29, 2012
All electronic submission information for this grant must be sent to: Please
include name of grant and name of your agency on the subject line of the email. Example: FY 13 UPK Open
Competitive, AB Child Care
Eligibility Requirement Criteria: Please indicate by marking “Yes” or “No” as to whether your program
satisfies the following eligibility requirements below.

Yes             No

                        1. EEC License or License-Exempt

                        2. Income Eligible Contract and/or Voucher Agreement

                        3. Access to Full-Day, Full-Year Services for Working Families

                        4. Developmentally Appropriate Program

                        5. Current NAEYC or NEASC Accreditation (Center-based) or Current NAFCC
                           Accreditation or CDA Credential or Higher [AA, BA, or Master’s Degree (FCC)]

                        6. Serve Pre-School-Aged Children

                        7. Self-Assessed Level 3 or Above in the Massachusetts QRIS

                        8. Serve “High Needs Children”

                        9. Screening and/or Formative Assessment Scores

                        10. Competitive Compensation Package for Lead Teachers

                        11. Program Match

                        12. Pre-Kindergarten – Third Grade Alignment

MA Standard Administrative Forms:
Complete and mail one original packet of the following forms with their Grant Application response. If the
applicant is submitting these documents with this application, check off the “Applicant use” boxes. If the
applicant already has these documents on file with the Commonwealth of MA, check “on file” boxes.
Applicant use: On File:         EEC Use:

                                     Commonwealth Terms & Conditions
                                     W-9 with DUNS #
                                     Contractor Authorized Signatory Listing
                                     Authorization for Electronic Funds Payment (EFT) Form
                                     Executive Order 504 Certification
                                     Supplier Diversity Program Plan Form (If the Grant is
                                     competitive and involves distributing more than $150,000 in
DO not submit additional information/document beyond requested grant application as these will not be
                                                                                         August 29, 2012

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