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									          21st Century Community Learning Centers




                                     Request for Proposals
                                     Application Guidance
                                           2013-2014
                                Due Date: 5:00 pm EDT March 22, 2013
                                         Maximum pages 50

The North Carolina Department of Public Instruction (NCDPI) is pleased to announce the 21st Century Community
Learning Center (CCLC) 2013-2014 Request for Proposals. The Application Guidance contains important information for
eligible entities applying for a grant under this program. Please note that all federal funds are contingent upon annual budgetary
Congressional approval.


Revised October 2012
The North Carolina Department of Public Instruction (NCDPI) is pleased to announce the 21st
Century Community Learning Center (CCLC) 2013-2014 Request for Proposals. The Application
Guidance contains important guidelines that applicants should follow when applying for a grant
under this program. The Application Guidance, the Grant Application template, and other
supporting materials may be downloaded from the NCDPI 21st CCLC website at:
http://www.ncpublicschools.org/21cclc/.

The 21st CCLC program is authorized under Title IV, Part B of the Elementary and Secondary
Education Act (ESEA). The program provides before and after-school, weekend, and summer
school academic enrichment opportunities for children attending low-performing schools to help
them meet local and state academic standards in subjects such as reading, mathematics, and science.
As a result of successful ESEA waiver application, effective in 2012-2013, 21st CCLC programs in
North Carolina may choose to also offer services during the school day. In addition, programs may
provide activities for youth development, drug and violence prevention, art, music, character
education, counseling, and recreation to enhance the program’s academic components. A third
component provides for family literacy programs.

Technical assistance is provided to potential applicants to describe general requirements of the 21st
Century Community Learning Center (CCLC) program, standards for North Carolina afterschool
programs, and required components of 21st CCLC applications for funding. Organizations that plan
to submit a grant proposal should attend one technical assistance workshop. For 2013-2014
applications, the following workshops will be provided:

      November 14, 2012, at the Craven County Board of Education, New Bern, NC
      December 13, 2012, at the Cone University Center, UNC Charlotte, Charlotte, NC
      January 16, 2013, at the Jane S. McKimmon Center, Raleigh, NC

In addition to the face-to-face meetings, NCDPI will conduct a webinar on February 6, 2013, from
1:00 pm to 2:00 pm focusing on the most frequently asked questions. Registration information for
the meetings and webinar can be found on the NCDPI website at:
http://www.ncpublicschools.org//21cclc/.

NCDPI expects to recommend approval of new grantees at the May 2013 meeting of the State
Board of Education (SBE). Upon approval, approved sub-grantees will be notified of their award by
mail. The notification will include specific information on meeting dates and times for additional
technical assistance workshops. Sub-grantees are strongly encouraged to attend all State sponsored
meetings.

Please note that NCDPI’s 21st CCLC program operates on a reimbursable basis. All proposals must
utilize the Wallace Foundation Out-of-School-Time Cost Calculator to determine proposed cost of
proposed program. The calculator may be used online at: http://www.wallacefoundation.org/cost-
of-quality/Pages/default.aspx.

Thank you for your interest in serving the students and families of North Carolina’s schools.




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                                                            CONTENTS


How to Apply ............................................................................................................................. 3

General Information .................................................................................................................. 4

Application Directions............................................................................................................. 19

      Section I: Certifications ................................................................................................ 19

      Section II: Executive Summary .................................................................................... 19

      Section III: Basic Program Information ...................................................................... 19

      Section IV: Program Narrative Based on the Principles of Effectiveness ................... 23

      Section V: Fiscal Management ..................................................................................... 28

      Section VI: Budget and Sustainability Plan ................................................................ 28

Application Review and Selection Process ............................................................................. 31

Appendix.................................................................................................................................. 33

      Appendix A: Glossary of Terms .................................................................................. 33

      Appendix B: Private School Consultation Form .......................................................... 36

      Appendix C: SAMPLE Partnership Agreement ........................................................... 37

      Appendix D: SAMPLE Measurable Goals and SMART Objectives ............................ 39

      Appendix E: Principles of Effectiveness ..................................................................... 40

      Appendix: F: Budget Forms ........................................................................................ 41

      Appendix G: Resources ................................................................................................ 45

      Appendix H: Application Rating Rubric ..................................................................... 47

      Appendix I: Application Package Checklist ................................................................ 57




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HOW TO APPLY
All applications will undergo a technical review to ensure the presence of basic components
including proposal sections, applicant and partner signatures, and other essentials outlined in this
Application Guidance such as required attachments. All applications must include the following
sections:

        Section I:      Certifications
        Section II:     Executive Summary
        Section III:    Basic Program Information
        Section IV:     Program Narrative Based on the Principles of Effectiveness
        Section V:      Fiscal Management
        Section VI:     Budget and Sustainability Plan

Applicants must use the application template attached to the guidance and adhere to the following
format throughout the development of the application package:

       Applications must be submitted in a paper format.
       Application sections must be clearly labeled with attachments numbered and submitted in
        the order requested.
       Application must be paginated and submitted in Times New Roman in 12-point font size.
       Applicants must submit one (1) original (signed in blue ink) and two (2) additional copies of
        the entire application.
       A CD-Rom of the paper application in portable document format (PDF) must be included.
       Applicants must submit all copies of the paper application and CD together in one package.

NOTE: Attach only the documents requested in the application instructions. Application
package including attachments must not exceed fifty pages total. Any pages submitted
beyond fifty will not be read.

Applications must be received by the NCDPI, Federal Program Monitoring Section by 5:00
pm EDT on March 22, 2013. E-mailed applications will not be accepted. Applicants are
responsible for sending application packages utilizing a delivery service (US Postal Service, UPS,
FedEx, etc.) that offers a tracking/delivery confirmation. NCDPI will not issue receipts. Applicants
are encouraged to carefully review the procedures for submitting their materials.

Completed applications must be submitted by mail to the following address:
      Brandon Patterson, Section Chief
      North Carolina Department of Public Instruction
      Federal Program Monitoring and Support
      6350 Mail Service Center
      Raleigh, North Carolina 27699-6350

Questions related to the 21st CCLC application should be directed to Richard Trantham at
Richard.trantham@dpi.nc.gov




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GENERAL INFORMATION
Purpose

The purpose of the Title IV, Part B, 21st Century Community Learning Center (CCLC) program is
to provide federal funds to establish or expand community-learning centers that operate during out-
of-school hours with three specific purposes:

1) Provide opportunities for academic enrichment, including providing tutorial services to
help students (particularly students in high-poverty areas and those who attend low-
performing schools) meet State and local student performance standards in core academic
subjects such as reading and mathematics.

The 21st CCLC program supports the creation of community learning centers that provide safe
learning environments for students during non-school hours (as of 2012-2013, waiver flexibility
permits approved programs in North Carolina to operate during an extended school day as well),
particularly students who attend high-poverty and low-performing schools. Centers provide a range
of services to support student learning and personal development. These services include, but are
not limited to, tutoring and mentoring, homework assistance, academic enrichment (such as hands-
on science or technology programs) community service opportunities, music, arts education, health
education, cultural activities, and physical activity including sports. Activities need to be engaging as
well as effective to ensure active student participation.

2) Offer students a broad array of additional services, programs and activities, such as
positive youth development activities, drug and violence prevention programs, counseling
programs, art, music, recreation programs, technology education programs and character
education programs that are designed to reinforce and complement the regular academic
program of participating students.

The program should be designed to improve academic achievement, but to also engage students in
quality enrichment opportunities. For students who have not been successful in the regular day
school, more of the same is not likely to produce success. In general, enrichment activities are multi-
disciplinary whereby the student must use academic skills from multiple subject areas learned during
the school day. Enrichment activities should also broaden students’ experiences by including the
arts, recreation, health, and cultural activities.

3) Offer families of students served by 21st CCLCs opportunities for math, science and
literacy related educational development.

21st CCLC programs must also offer families of participating students educational and personal
development opportunities, particularly in the area of literacy. Effective 21st CCLC programs
sponsor parent engagement opportunities to support a child’s academic and social development that
are different and more frequent than have been traditionally offered by the regular school day
program.




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Eligibility to Apply

Any public or private organization is eligible to apply for a 21st CCLC grant. Agencies and
organizations eligible under the 21st CCLC program include, but are not limited to: local education
agencies (LEAs), non-profit agencies, city or county government agencies, faith-based organizations,
institutions of higher education, and for-profit corporations.

Section 4204(b)(2)(H) of Title IV, Part B, requires applicants provide a description of the
partnership between a local educational agency, a community‐based organization (CBO), and other
public or private organizations, if appropriate. If the local applicant is another public or private
organization (e.g., an organization other than a school district), it must provide an assurance that its
program was developed and will be carried out in active collaboration with the schools the students
attend.

Priority for Awards

In accordance with statute, States must give competitive priority to applications that both propose to
serve students who attend schools identified for improvement (pursuant to Section 1116 of Title I)
and that are submitted jointly between at least one LEA receiving funds under Title I, Part A and at
least one public or private community organization. Although the statute provides an exception to
this requirement for LEAs that do not have qualified community organizations within reasonable
geographic proximity, such LEAs would still have to propose to serve students attending schools
identified for improvement to qualify for the priority. (Note ESEA Flexibility section below.) For a
list of Title I schools, go to: http://www.ncpublicschools.org/program-monitoring/.

Based on current research-based best practices, the State will give priority to proposals that are
designed to implement programs focusing on Science Technology, Engineering, and Mathematics
(STEM) initiatives, and proposals designed to serve underserved geographical regions of the state.
(See page 32 for additional information)

ESEA Flexibility

In May 2012, North Carolina was granted flexibility waivers from many of the NCLB provisions.
This flexibility, granted by the U.S. Department of Education, makes significant changes to North
Carolina’s implementation of the Elementary and Secondary Education Act (ESEA) requirements
especially in the areas of Adequate Yearly Progress, parent notifications, public school choice and
supplemental educational services (SES). These waivers will allow North Carolina’s public school
system to move forward with strengthened College- and Career-Ready expectations for all students,
new ways to hold Title I schools accountable for students' academic proficiency, and new initiatives
to support effective instruction and leadership. Many of the former strict federal requirements
regarding Adequate Yearly Progress (AYP) and sanctions for schools that do not make AYP are no
longer required statewide and are now local school district decisions.

Beginning with the 2012-2013 school year, LEAs are no longer required to identify Title I schools
for improvement, corrective action, and restructuring and are no longer required to take certain
improvement actions as outlined in ESEA section 1116(b) such as offering public school choice and
SES. While schools will still be measured against annual measurable objectives (AMOs) calculated
and reported under ESEA, the new standards will recognize growth in performance and will no

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longer be the “all or nothing” targets of the past. North Carolina’s goal is to provide more and
stronger support to enable all students to graduate from high school career and college ready.

Included in NC’s approved request is the optional waiver to provisions of sections 4201(b)(1)(A)
and 4204(b)(2)(A) that restrict the activities provided by a community learning center under the 21st
CCLC program. ESEA flexibility would not affect current 21st CCLC sub-grantees. Rather, this
flexibility will take effect for local competitions conducted after an SEA receives ESEA flexibility.
Thus, in NC’s 2013-2014 21st CCLC competition, eligible entities may apply to provide activities
that support high-quality expanded learning time in addition to activities conducted during non-
school hours or periods when school is not in session such as before school, evening, weekend,
holidays, summers or other school vacation periods.

An eligible entity in a State that has been approved to implement ESEA flexibility (and has
requested the optional flexibility for the 21st CCLC program) may use up to ten percent of the 21st
CCLC funds to provide activities that support high-quality expanded learning time. The 21st CCLC
activities may be carried out at any point in time during an extended school day, week, or year. For
example, if an LEA lengthens its school day beyond the State minimum, the LEA or another eligible
entity might use 21st CCLC funds to provide supplemental science, reading, civics, or art instruction
or other supplemental academic enrichment activities to students in the morning or afternoon to
allow teachers time to collaborate or plan. Similarly, an LEA, working with a community partner,
might use 21st CCLC funds to extend its school week and incorporate enrichment activities, such as
debate or college preparation, on either Saturday or a weekday. Using 21st CCLC funds to support
expanded learning time should not be just “more of the same” it should involve careful planning by
the eligible entity to ensure that the programs or activities will be used to improve student
achievement and ensure a well-rounded education that prepares students for college and careers.

Supporting activities to provide high-quality expanded learning time might include:

      Adding significantly more time by expanding the school day, school week, or school year to
       increase learning time for all students;
      Using the additional time to support a well-rounded education that includes time for
       academics and enrichment activities;
      Providing additional time for teacher collaboration and common planning; and
      Partnering with one or more outside organizations, such as a nonprofit organization, with
       demonstrated experience in improving student achievement.

With the exception of carrying out 21st CCLC activities during an expanded school day, week, or
year, an eligible entity in a State that receives a waiver must comply with all other 21st CCLC
requirements. In other words, other provisions of the 21st CCLC program remain unchanged. For
21st CCLC programs approved for 2013-2014, not more than ten percent (10%) of the annual total
award may be used for expanded learning within the regular school day. Additional information
about how the federal ESEA program is implemented is available on the Federal Program
Monitoring website at: http://www.ncpublicschools.org/program-monitoring/esea/.




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Initial Award Amounts

Applicants may request funds ranging from $100,000, not to exceed $400,000 per year based on
need and must include funds for summer programming. New proposals must utilize the Wallace
Foundation Out-of-School-Time Cost Calculator to determine cost of proposed program and
requested funding. The calculator may be used online at: http://www.wallacefoundation.org/cost-
of-quality/Pages/default.aspx.

Note that the NCDPI 21st CCLC program operates on a reimbursable basis. When considering the
amount to be requested, applicants are reminded to be aware of the needs of the community and the
number of centers to be implemented.

Award Periods

North Carolina 21st CCLC programs are renewable for up to four years. Continuation awards are
contingent upon availability of federal funds and are based on the programs ability to demonstrate
compliance with state and federal law, sufficient progress toward local program goals, and sufficient
progress toward State performance indicators.

Each sub-grantee can be awarded funds for the academic year starting on July 1st of the initial year
and ending on August 31st of the following year (e.g., July 1, 2013 through August 31, 2014).
Reimbursement requests may be made through September 30th for expenditures made prior to
September 1st. Unspent funds remaining after the end of the grant period will revert without a
liquidation period.

In each year of implementation, attendance records for grantees are carefully monitored to
determine if sufficient progress is made toward attendance goals identified in the approved project.
Monitoring includes on-site visits as well as required quarterly reporting. Funds are allotted in three
installments based on the grantee’s demonstration of sufficient progress toward attendance goals as
follows:

      Initial allotment equal to 34% of total approved grant award;
      Second allotment equal to 34% of the total approved grant award for 50% attendance goal
       met; and
      Final allotment equal to 32% of the total approved grant award for 75% attendance goal
       met.

If at any time during the first year or in subsequent years of continuation awards it is determined
that attendance goals are not sufficiently met to support the total approved grant award, the sub-
grantee may request a voluntary reduction or termination of the grant. If a grantee requests a
voluntary reduction in the first year of the grant award, but is able to increase attendance in
subsequent years of the renewal period, the total award for that year may be made available for the
sub-grantee’s 21st CCLC program if sufficient documentation is provided to ensure that attendance
goals are met.




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Program Participants

States are required to award grants to applicants that will primarily serve students who attend
schools with a high concentration of students from low-income communities. Programs may be
offered for students attending grades K-12. For activities carried out in public schools, the 21st
CCLC grant requires equitable participation of private school students, students with disabilities,
teachers, and other educational personnel who are a part of the target population.
Program Activities

21st CCLC program activities are those statutorily authorized events or undertakings at the center
that involve one or more program participants. A wide variety of activities should be offered in the
21st CCLC program aligned to the identified needs of the community and schools served. Activities
should be engaging, age-appropriate, and based on the needs and interests of the participants. Types
of services offered by sub-grantees to participants may vary from site to site, but must include
components that focus on core academic subjects in order to allow students to improve academic
achievement.

NOTE: All 21st CCLC programs must implement academic activities aligned to the
Common Core State Standards for reading/language arts and mathematics and all other
academic content areas aligned to the North Carolina Essential Standards. For information,
go to: http://www.ncpublicschools.org/acre/standards/.

Each eligible organization receiving an award will use the funds to carry out a broad array of
activities that advance student achievement. In order to meet the Principles of Effectiveness,
activities developed for the afterschool program must:

       (1)     Be based upon an assessment of objective data regarding the need;
       (2)     Be based upon an established set of performance measures aimed at ensuring the
               availability of high quality academic enrichment opportunities; and
       (3)     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 (United States Department of Education, 2007).

Sub-grantees are required to provide activities that focus on math and reading. Other activities may
include, but are not limited to, the following activities that are based on the needs of the population
served:

      Mathematics and science activities;
      Arts education;
      Entrepreneurial education programs;
      Reading literacy;
      Tutoring services (including those provided by senior citizen volunteers) and mentoring
       programs;
      Programs that provide afterschool activities for limited English proficient students that
       emphasize language skills and academic achievement;


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      Health enhancing recreational learning activities;
      Telecommunications and technology education programs;
      Expanded library service hours;
      Programs that promote parental involvement and family literacy;
      Programs that provide assistance to students who have been truant, suspended, or expelled;
      Health education including drug and violence prevention programs and character education
       programs; and
      Counseling programs.

In general, 21st CCLC programs activities are defined as follows:

Academic Enrichment Learning Programs: Enrichment activities expand on students' learning
in ways that differ from the methods used during the school day. They often are interactive and
project focused. They enhance a student's education by bringing new concepts to light or by using
old concepts in new ways. These activities are fun for the student, but they also impart knowledge.
They allow the participants to apply knowledge and skills stressed in school to real-life experiences.

Academic Improvement/Remediation Programs: These activities specifically target students
whose academic performance has been deemed to be in need of improvement given that the student
is not performing at grade level, is failing, or is otherwise performing below average. Academic
improvement programs are designed to address deficiencies in student academic performance.
Activities in this category may involve tutoring, academic enrichment, or other forms of service
delivery that specifically involve students identified as in need of academic improvement.

Activities for Limited English Proficient Students: These activities specifically target students
with limited English proficiency and are designed to further enhance students' ability to utilize the
English language.

Activities Targeting Adult Family Members: Activities Targeting Adult Family Members must
require ongoing and sustained participation by the adult family member in order to achieve the
acquisition of knowledge or a skill that is meant to be imparted through participation in the service
or activity. Examples of activities that conform to these requirements would include GED classes,
classes on how to develop a resume, or a programming series on effective parenting strategies.
Episodic, non-recurring, or special events are likely not to conform to these requirements. For
example, an open house night for the parents of children attending the center that involves a meal
and social activities would not conform to these requirements.

Activities That Target Truant, Expelled, or Suspended Students: These activities specifically
target truant, expelled, or suspended students and are designed to re-engage these students in
educational services that have estranged these students from traditional educational settings and/or
address academic attainment/behavioral issues through counseling and support.

Career/Job Training: These activities may target either youth or adults participating in the 21st
CCLC program and are designed to support the development of a defined skill set that is directly
transferable to a specific vocation, industry, or career. For youth participating in center
programming, activities that are designed to expose youth to various types of careers and which help



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inform youth of the skills needed to obtain a given career could also be considered in this activity
category.

Community Service/Service Learning Programs: These activities are characterized by defined
service tasks performed by students that address a given community need and that provide for
structured opportunities that link tasks to the acquisition of values, skills, or knowledge by
participating youth.

Drug and Violence Prevention, Counseling, and Character Education Programs: These
health-enhancing activities are designed to prevent, intervene, or stop youth from engaging in high-
risk behaviors including the use of drugs and alcohol or intentional/unintentional violence or injury.
These activities also reduce risk-taking behaviors by teaching and assessing the essential health skills,
promoting positive youth development, resiliency, and social emotional learning, providing
opportunities for counseling and support, and establishing a sense of connectedness by cultivating
core ethical values such as caring, honesty, fairness, responsibility, and respect for self and others.

Expanded Learning Opportunities: Targeted interventions that can include: teacher articulation
and professional development, student tutoring, application of available technology and resources,
cross curricular project based learning, service learning and internships that occur either within the
confines of regular school day, extend the regular school day, or occur in out of school time
programming.

Expanded Library Hours: 21st CCLC funds are used specifically to expand the normal operating
hours of a library.

Homework Help: Homework help refers to dedicated program time for students to work
independently on homework, with or without assistance from staff, volunteers, or older peers.

Mentoring: Mentoring activities primarily are characterized by matching students one-on-one with
one or more adult role models, often from business or the community, for guidance and support.

Programs That Promote Parental Involvement and Family Literacy: These activities
specifically target adult family members of youth participating in the 21st CCLC program and are
designed to more actively engage parents in supporting the educational attainment of their children
and/or enhance the literacy skills of adult family members.

Recreational Activities: These activities are not academic in nature, but rather allow students time
to relax, play, or engage in health-enhancing fitness opportunities. Sports, games, and clubs fall into
this category. Occasional academic aspects of recreation activities can be pointed out, but the
primary lessons learned in recreational activities are in the areas of social skills, teamwork,
leadership, competition, and discipline.

Regular School Day: A traditional 6.5 hour instructional school day.

STEM: Science, Technology, Engineering, and Mathematics (STEM) programs inspire and
encourage students by engaging them in hands-on, experiential, inquiry-based, and learner-centered
activities (including engineering design processes) that embrace each STEM component and their
interrelationship not just in theory but in real world practice.


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Tutoring: These activities involve the direct provision of assistance to students in order to facilitate
the acquisition of skills and knowledge related to concepts addressed during the school day. Tutors
or teachers directly work with students individually and/or in small groups to complete their
homework, prepare for tests, and work specifically on developing an understanding and mastery of
concepts covered during the school day.

Youth Leadership Activities: These activities intentionally promote youth leadership through skill
development and the provision of formal leadership opportunities that are designed to foster and
inspire leadership aptitude in participating youth.


Summer Programs

Summer programs afford students an opportunity for year-round learning. Year-round learning
consists of intentional, community-based efforts to link school, afterschool, and summer learning
for the benefit of youth. Implementing summer learning programs can benefit youth in the
following areas: better grade transition, prevention of academic loss, and greater exposure to
experiential learning opportunities (Harvard Family Research Project, 2011). In addition, the Wallace
Foundation finds that summer programs provide a safe and structured learning environment. Most
importantly, summer programs can keep students focused and learning—and can mitigate academic
losses over the summer.

Beginning with the 2013-2014 competition, all 21st CCLC proposals submitted must include a
three-year plan for a summer component. The intent of the summer component is for youth to
engage in additional academic and enrichment activities by doing the following:

      Aligning work with school and district standards;
      Maintaining and advancing the academic gains made during the school year;
      Exposing youth to new learning environments through project-based hands-on learning;
      Increasing family engagement and community engagement;
      Providing key supports to help youth get and stay on a pathway to high school, college, and
       beyond; and
      Encouraging and tracking participation across the year and over time to ensure youth stay
       involved and engaged.

At a minimum, the following components must be included in the applicant’s proposal to
address an effective summer program:

      Academic activities that are aligned to the Common Core Standards;
      Plans to reduce the academic disparity during the summer months;
      Demonstrated partnership between the local school district and the community at-large; and
      Hours of operation sufficient to meet program goals (recommended minimum of 12 hours
       per week).

In addition, summer programs must serve as an extension of the yearlong program and must adhere
to the same guiding principles as the proposed yearlong program.

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In formulating your summer component, make sure to follow the same format you followed for the
year-long program. The following resources will assist applicants in the design of the summer
component:
     http://www.afterschoolalliance.org/documents/Special_Report_on_Summer_052510.pdf
     http://www.thechildrenstrust.org/programs-guide
     http://www.hfrp.org/out-of-school-time



Location of Centers

21st CCLC programs may be located in schools, community and/or faith-based facilities. If
programs are operated in facilities other than a school, the facility must be at least as available and
accessible to the participants as if the program were located in a school. Program officials are
reminded of their obligation under Section 504 of the Rehabilitation Act to ensure that facilities for
community learning center programs must be accessible to persons with disabilities. Regardless of
where the program takes place, program officials must ensure that students travel safely to and from
the community learning center and home and must provide information on how this will be
accomplished in the application narrative.

Student Contact Hours

Program officials must demonstrate that adequate and quality contact time will be spent with
students each week. Research has proven that brief periods of contact time in before or after school
programs do not significantly contribute to improving student outcomes. It is recommended that
programs operate at least three hours a day and at least twelve hours each week (including Saturdays)
during the school year, including before and after- school hours. Programs should serve the same
students on a daily basis.

Staffing

Staff members are hired according to the sub-grantee’s procedures and policies. Sub-grantees must
ensure that staff members have received appropriate and thorough training on program
requirements, program design, and program goals and objectives. Staff must be well informed about
their job descriptions, performance expectations, and information regarding the evaluation of their
job performance.

The Program Director serves as the leader for the local 21st CCLC program. The director is
responsible for the comprehensive implementation of the program based on the needs of the staff
and population served.

The North Carolina Afterschool Professional Core Competencies should serve as a guide to directors for
identifying appropriate staff for each level of responsibility in the 21st CCLC program. The
competencies outline eight key content areas of skill and knowledge for afterschool program staff
and are categorized according to five levels necessary to ensure quality programming. The skill levels
establish a continuum from beginning workforce skills (Level 1) to an advanced level of skill, which
includes academic preparation (Level 5). Depending on a professional’s role, setting, or experience,


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he or she may have skills at varying levels in the different areas. Not all programs will employ staff
persons at each level.

For a full copy of the competencies and descriptions of each content area, refer to:
http://nccap.net/about/useful.cfm. The site also offers an evaluation instrument, sample job
descriptions, and sample professional development plans.

Staff Training/Professional Development

A well-trained staff is critical to the success of a 21st CCLC program. Initial and ongoing staff
training increases the likelihood that all program goals will be met. All staff and volunteers should be
appropriately trained on policies and procedures related to expectations for staff, student
engagement, and student health, safety and well-being.

In addition to using the North Carolina Afterschool Professional Core Competencies as a guide for selecting
staff, this valuable resource should also be used when making decisions about professional
development for staff working in the 21st CCLC program. Identifying existing skills and knowledge
of each staff member serves as a way to individually support professional growth with skills and
abilities necessary to work with school-age children and youth in out-of-school time programs.
Written professional development plans should include both activities for all staff as well as activities
to address individual staff needs.

The competencies also serve as the foundation for the North Carolina Afterschool Professional
Development System. Developed through collaborative partners with NC CAP, the system provides
an online centralized database of afterschool training opportunities across the state. The database is
searchable by filters (county, staff level, content area, etc.). To search for available professional
development offerings, go to: http://nccap.net/about/useful.cfm.

Evaluation

Program evaluation is a key component of the 21st CCLC program. Evaluation allows the state and
federal government to insure the wise use of public moneys and enables program directors to chart
progress toward program goals and objectives. Local evaluation results must be used to strengthen
the local program and revise program goals and objectives as needed.

Applicants must describe the goals of the 21st CCLC program and specific measurable objectives
that will determine progress toward those goals. Applicants may identify goals and objectives based
on local needs and aligned to the State’s performance indicators. NCDPI performance indicators
include: (1) increases in percentages of students regularly participating in the program who meet or
exceed state and local academic achievement standards in reading and mathematics (e.g., EOC,
EOG, etc.) and, (2) the percentage of students who show improvement in report card grades, and
(3) behavior measures such as school attendance, classroom participation, and decreased disciplinary
actions or other adverse behaviors.

Matching Funds and Sustainability

Matching funds, which includes state, federal, private, or other alternative funding, are not required
to apply for a 21st Century Community Learning Center Program grant. Although grants are


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awarded for four years, there is a gradual reduction in funding beginning in year three. There is a
20% reduction in the amount of the award in year three (3) and in year four (4) the amount of the
reduction is 40%. The reduction of funds is devised to promote programs to acquire funds and
other resources to ensure the program is sustainable by the end of the grant period. A formal
sustainability plan is a requirement of the grant application and critical to the long-term success of
the program.

NOTE: It is recommended that applicants seek North Carolina Child Care Standard Licensing for
programs with children less than 12 years of age as a means to sustaining. For additional
information, go to the North Carolina Division of Child Development, Department of Health and
Human Services' web site at: http://www.dhhs.state.nc.us/dcd/.

Fiscal Management Standards

EDGAR Part 80 specifies the fiscal requirements for grants and the associated agreements with state
and local governments. Standards for financial management systems include:

      Effective control and accountability must be maintained for all grant and sub-grant cash, real
       and personal property, and other assets.
      Grantees and sub-grantees must adequately safeguard all such property and must assure that
       it is used solely for authorized purposes.
      Actual expenditures or outlays must be compared with budgeted for each grant or sub-grant.
      Accounting records must be supported by such source documentation as cancelled checks,
       paid bills, payrolls, time and attendance records, contract and sub-grant award documents,
       etc.

EDGAR does not stipulate a particular kind of accounting system. However, it is not sufficient to
record that $5,000 was spent on equipment. The accounting system must maintain $5,000 was spent
on a computer from [NAME] Company and the date of the purchase. Spreadsheet programs,
especially for smaller grantees, are usually sufficient.

Fiscal Policies and Procedures

Written fiscal procedures including job descriptions must be in place. The procedures should
emphasize how the sub-grantee segregates duties. As applicable, policies should be in place for
procurement, vendor payment, inventory, payroll time and distribution, cash requests and records
retention. And, most important, these procedures must be followed.

Personnel Activity Reports

The purpose of the personnel activity report (PAR) is to certify and verify that the employee’s salary
paid from the grant funds is commensurate with his/her percent of effort worked on the grant.
There are different requirements depending on the type of organization.

The time and effort reporting requirements for a non-profit organization are defined in Circular A-
122 and are as follows:


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         Multiple Cost Objectives                           Single Cost Objectives
         Monthly Report                                     Monthly Report
         Signed by employee or supervisor                   Signed by employee or supervisor
         After the fact                                     After the fact
         Account for 100% of time                           Account for 100% of time


Audits

Audits must be conducted by a certified public accountant (CPA) or by an accountant certified by
the Local Government Commission (LGC) as qualified to audit local government accounts. The
audits shall be performed in accordance with generally accepted auditing standards (GAAS) and the
financial statements must be prepared in conformity with general accepted accounting principles
(GAAP). All applicants are required to submit the most recently completed audited financial
statement with this grant application. If no statement is available, applicant must attach a written
statement explaining why audit information is not available.

Budget Preparation

Applicants must be able to demonstrate the extent to which the costs are reasonable and necessary
in relation to the number of students and adults to be served and the correlation to the anticipated
results and benefits. All items included in the budget must clearly relate to activities described in the
program design section of the application. No item should be identified in a budget that has
not been explained in the program narrative. Post-award changes in budgets and projects require
the prior written approval of NCDPI.

Applicants should exercise caution in selecting subcontractors to implement program components.
In Section 80.35 of EDGAR, grantees may not make awards or contracts to any party that is
debarred or suspended or excluded from or ineligible for participation in federal programs under
Executive Order 12549, “Debarment and Suspension.” For NC Debarred Vendors, go to:
http://www.doa.state.nc.us/PandC/actions.asp. For Federal Excluded Parties List System, go to
https://www.epls.gov/.

        All technology expenses require pre-approval from DPI and expenses of this type must be
         (1) reasonable, (2) allocable and (3) allowable.
        In Section 80.32 of EDGAR, grantees must conduct an inventory of equipment purchased
         with grant funds once every 1-2 years and reconcile that information with the property
         records. For purposes of this grant, an equipment inventory is required annually. Equipment
         includes all devices, games and equipment costing over $100.00.
        If equipment is to be used during the regular school day hours, the cost of the equipment
         must be prorated based upon percentage of use.
        Edgar Part 80 specifies that effective control and accountability must be maintained for all
         grant cash, real and personal property, and other assets. The “Fiscal Guidance” available at:
         http://www.ncpublicschools.org/21cclc/ explains these requirements.
        The federal guidelines allow student incentives with no intrinsic value (i.e., less than $25.00).
         All legitimate expenses must be included in the budget. (e.g., T shirts, a free book, etc.). Note
         that no direct cash can be given to students.

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NOTE: The proposed budget submitted with the 21st CCLC application is not the approved
budget for release of funds. If the application is approved, sub-grantees must submit a final
budget for the full amount of the award for review and approval prior to the release of funds.
Program implementation cannot occur until the final budget has been approved by NCDPI.
Since 21st CCLC grants are made available on a reimbursement basis, it is strongly
encouraged that applicants have secured sufficient funding or a line of credit to operate the
21st CCLC program for approximately a two-month period.

Use of Funds

Grant funds must be used in a manner consistent with all requirements of the statute and must be
used only to supplement, not supplant, any federal, state or local dollars available to support
activities allowable under the 21st CCLC program. Funds may be used to expand or enhance, but not
replace, current activities. Proposed budgets must be developed in consideration of costs that are
reasonable and necessary to fulfill the goals of the 21st CCLC grant. Sub-grantees are strongly
encouraged to attend all training provided to assist non-LEAs and LEAs on budget and
operational requirements, as related to the Educational Department General Administrative
Regulations (EDGAR).

Funds may be used for program implementation as well as for operational expenses, including, but
not limited to the following:
     Personnel and personnel benefits;
     Staff development and training;
     Consultants, subcontracts and evaluators;
     Leasing vehicles and other transportation costs;
     Educationally-related field trips;
     Renting space, if necessary;
     Teacher substitutes;
     Travel reimbursements; or
     Classroom equipment and supplies, including computers and software.

NOTE: LEAs that choose to cost share (split-fund) 21st CCLC-funded equipment, materials,
and staff with the activities occurring during the regular school day, must provide evidence
that the percentage of use or full-time equivalent (FTE) is correlated to the percentage
charged to the 21st CCLC vs. regular school day activities.

Funds may NOT be used for the following:
      Costs for developing the proposal;
      Land acquisition;
      Building or renovation costs;
      Purchase of vehicles;
      Cost of conducting an audit if total of all federal grants received is less than $500,000; or
      Other items outlined in the Education Department General Administrative Regulations
       (EDGAR), the guidelines on federal spending at:
       http://www.ed.gov/policy/fund/reg/edgarReg/edgar.html.


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NOTE: This is NOT an all-inclusive list of non-allowable expenses.


Limit on Indirect Cost and Evaluation Cost

Indirect cost rates for LEAs and non-LEA’s are calculated by the NC DPI and communicated to
grantees on an annual basis. Grantees may spend no more than the calculated rate of each year’s
budget on activities related to the fiscal agent’s administration of the 21st CCLC grant (Indirect
Cost).

The use of an external evaluator is allowed, but not required. The cost of the external evaluation
must not exceed an amount equal to three percent (3%) of the total grant award.

Uniform Chart of Accounts

All budgets must be developed and submitted using the Uniform Chart of Accounts (COA). The
COA is available at: http://dpi.state.nc.us/fbs/finance/reporting/coa2011. Look in the Working
Documents section.

The account code structure consists of four dimensions. The dimensions are: 1) fund, 2) purpose, 3)
program report code, and 4) object:

   1) Fund Code - consists of one numeric digit. The fund is an independent fiscal accounting
      entity with a self-balancing set of accounts. (e.g., federal fund code is 3).
   2) Purpose Code - consists of four numeric digits and describes the purpose for which the
      activity exists or the type of balance sheet account. (e.g., function code
   3) Program Report Code (PRC) - consists of three numeric digits. The program report code
      describes the funding for a particular activity. (e.g., PRC 110)
   4) Object Code - consists of three numeric digits. The object is the service or commodity
      obtained as the result of a specific expenditure. (e.g., Teacher's Salary is code 121;
      Instructional Supplies is code 411).

Only the codes listed in the COA for PRC 110 are allowable for use. Code descriptions may be
found at http://dpi.state.nc.us/fbs/finance/reporting/coa2011. Look in the COA Supporting
Documents section.

Uniform Education Reporting System

The Uniform Education Reporting System (UERS) is the required accounting system specification
and process designated by the state to help ensure uniform, standard and accurate reporting of fiscal
data on the use of funds. The fundamental objective of the UERS is to provide a simple process of
reporting expenditures in a public education environment. Grantees will be required to adhere to
the UERS accounting system expectations.

   1) Cash Requests
      The deposit of federal funds will be made directly to a local bank account by electronic
      transfer through a program offered by the Office of the State Treasurer. Every fiscal agent
      that is a non-LEA must complete this State Treasurer's form. The State will assign a unique


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   banking vendor number and process the form with the State Treasurer's Office. In order to
   practice sound fiscal management of cash, it is necessary that cash balances from the bank
   account be reconciled with those at DPI on a monthly basis.
2) Expenditure Reporting
   Expenditures must be reported to DPI. Each approved fiscal agent will be assigned a unique
   number identifier (i.e., Unit Number) that must be included on each expenditure record
   submitted to the state. Non-LEAs must have prior approval from DPI before purchases are
   made. LEAs are expected to receive approval in BUD.
3) Budget Amendment/Revision
   Budget amendments/revisions (changes to the budget) can be submitted anytime during the
   approved grant period. Budget amendments along with appropriate justification and
   programmatic change (if applicable) should be sent to the DPI 21st CCLC Consultant for
   review and approval. The Consultant will verify that the request meets with the requirements
   of the grant. Budget amendments are required if the cumulative total of the over-expended
   account(s) exceed(s) 10% of the current total approved budget or if there are significant
   changes to the grant proposal.




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APPLICATION DIRECTIONS

A template is provided to assist applicants with completion of all required components for review. Textboxes may be expanded as
needed and additional rows may be inserted as appropriate.

Section I: Certifications

Applicants should read carefully all Assurances listed on the 21st CCLC Grant Application. Any
questions on these Assurances may be discussed during one of the technical assistance workshops.
The Assurances, Debarment Certification, and the Criminal Background Check Certification pages
must be signed by an authorized representative of the organization seeking the grant in order for the
application to be considered.

NOTE: The current list of North Carolina conventional non-public schools (i.e., private schools) is
available at: http://www.ncdnpe.org/convnonpub.aspx.

Attachment 1: Attach the completed Private School Consultation Form (Appendix B).

Section II: Executive Summary

Executive summaries are much like any other summary in that their main goal is to provide a
condensed version of the content of a longer proposal. The executive summary is typically written
after the entire proposal is complete and can be viewed as a synopsis of the key aspects of the
proposed project. An executive summary:

        Consists of short and concise paragraphs;
        Only includes content written in the proposal;
        Frames the intent of the proposal and
        Describes how the proposal will meet the needs of the target population.

Please note that the executive summary is limited to no more than three pages in length.

Section III: Basic Program Information

Complete all program information in the application. Include additional pages if needed for
programs with multiple collaborative partners or for more than two program sites.

A. Organization Information

All organization information must be completed. The General Contact Person is considered the
primary contact during the review and notification process. Information provided in this section will
be used to notify the applicant as to the status of the application whether it is approved or not
approved. The General Contact Person is responsible for notifying schools and collaborative
partners of any communication from NCDPI. If an application is approved, the Project Director
will be considered the primary contact for the 21st CCLC program throughout implementation. If at
any time a change occurs for the General Contact Person or Project Director, it is the responsibility
of the General Contact Person to notify NCDPI of persons or information that change.


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B. Organization Type

Organization type is considered during the initial approval process to ensure equitable opportunity is
provided to all organization types. If at any time the Organization Type changes, it is the
responsibility of the General Contact Person to notify NCDPI of information that changes.

C. Fiscal Agent

For the purposes of the 21st CCLC program, the fiscal agent is generally the eligible entity that is
authorized to receive funds from NCDPI. Among other things, the fiscal agent is responsible for
receiving, managing, and administering all financial costs and expenditures in accordance with
program requirements, and maintains the documentation needed to support the use of funds. The
fiscal agent is responsible for ensuring that sub grantees (including other partners when the sub-
grantee is a group or partnership) and contractors are aware of the requirements associated with
maintaining verifiable fiscal records associated with the services or other contributions provided by
the organization. If at any time the Fiscal Agent changes from the one identified in the approved
proposal, it is the responsibility of the General Contact Person to notify NCDPI of any changes.

D. Collaborative Partners

The establishment of collaborative partners is critical to both the implementation and sustainability
of the 21st CCLC program. A collaborative partner provides routine, regular, and ongoing services to
the program as outlined in a signed memorandum of agreement (e.g., the regular use of facilities and
equipment, mentors/tutors, etc.). A collaborative partner plays a critical role in sustaining the
program as grant funds decrease.

A partnership signifies meaningful involvement in planning, as well as specific individual or joint
responsibilities for program implementation. The application must contain signed Partnership
Agreements with each partnering agency that describes their significant involvement in planning and
program implementation. A sample Partnership Agreement is provided in the Appendix that may be
used as a guide to develop customized agreements. Please do not submit letters of support. Only
those documents specifically requested as attachments will be reviewed.

Priority is given to applications that are submitted jointly by an LEA and a collaborative partner, or a
non-LEA organization that secures the LEA as a collaborative partner. Applicants must submit
information for collaborative partners that have committed to support the implementation and/or
sustainability of the program.

NOTE: An individual, agency, organization or other entity that only provides services
described in the proposed program is considered a vendor, not a partner. Therefore, a
Partnership Agreement is not required. For the purpose of this funding, the required
independent evaluator is a vendor, NOT a partner.

Attachment 2: Attach a copy of each customized partnership agreement. (Appendix C)




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E. Collaboration with Schools

Applicants must collaborate with partners including the eligible school(s) the students attend. A
partnership signifies meaningful involvement in planning, as well as specific individual or joint
responsibilities for program implementation. Students can be easily confused by different methods
of presenting academic material, so coordination of program learning activities with the school is
important. A variety of activities can enhance learning, but consistency of content and methods is
critical for enhancing understanding. Also, the synchronization of the content presented between
the school and 21st CCLC program will help to reinforce learning. The applicant should indicate the
primary point of contact at the feeder school(s) and describe the process for ongoing and regular
communications with the feeder school(s) as well as specific procedures that will be used to
coordinate learning activities with the classroom teacher or other school staff. If the applicant is a
non-LEA organization, the organization is encouraged to seek support from the school principal to
ensure agreement with the school/21stCCLC Program communication/coordination plan.

F. Program Director

The program director serves as the leader and is responsible for the day-to-day operations of the 21st
CCLC program. The director is responsible for the comprehensive implementation of the program
based on the needs of the staff and population served. Applicants are encouraged to use the NC
Afterschool Professional Core Competencies when determining the most effective person for the
Program Director position. For a copy of the competencies, see http://nccap.net/about/useful.cfm.

The director’s responsibilities include, but are not limited to the following:

       Provide general oversight of program implementation at all centers:
          o Conduct routine scheduled site visits;
          o Review appropriate documentation and records;
          o Maintain consistent communication with site coordinators;
          o Maintain documentation to support on-going programmatic review;
       Develop a process for monthly data collection and reporting for each site;
       Maintain a weekly ledger of the budgetary expenses;
       Develop job descriptions for key staff;
       Select staff that can meet the demands of operating an afterschool program;
       Maintain and communicate to staff a clear understanding of all proposal components;
       Communicate goals and objectives of the program to staff, volunteers, parents, and
        community members;
       Develop and communicate written policies and procedures to address staff expectations,
        program guidelines, and requirements for student health and safety;
       Maintain procedures to ensure high quality staff performance:
          o Develop instruments to evaluate staff performance;
          o Establish a reward or incentive system such as employee of the month;
          o Identify professional development opportunities for staff aligned to the North Carolina
             Afterschool Professional Core Competencies;
       Submit requested reports to the state department and federal government; and



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      Conduct an annual evaluation of the 21st CCLC program aligned to the North Carolina
       Established Standards of Excellence that measure the success of program implementation
       and substantiate that sufficient progress is demonstrated toward program goals and
       objectives.

At a minimum the job description for the director must include 1) a summary of the position; 2)
knowledge and skills required; 3) essential duties; and 4) qualifications (i.e., education and related
work experience).

Attachment 3: Attach 1) a job description for the program director; 2) a resume for the
program director; and 3) a brief explanation as to why the individual selected has the
experience and knowledge to direct the 21t CCLC program.

G. Sites

Applicants must provide information for each site where 21st CCLC programs will operate. If
programs are operated in facilities other than a school, the facility must be at least as available and
accessible to the participants as if the program were located in a school. Program officials are
reminded of their obligation under Section 504 of the Rehabilitation Act to ensure that facilities for
community learning center programs must be accessible to persons with disabilities.

Information provided on each site will be used to determine if the program is of sufficient scope to
impact the academic achievement of participating students and if the budget for the program is
appropriately developed. Prospective sub-grantees must demonstrate that adequate and quality
contact time is being spent with students and families each week. Research has proven that brief
periods of contact time in before and afterschool programs are not beneficial to students. It is
recommended that each enrolled student be provided academic enhancement activities a minimum
of 12 hours each week (occurring between Monday and Saturday) in order to maximize the impact
on students' development and learning. A sample one-month programmatic schedule must be
included for each site.

Applicants must include the proposed schools that will be served in the 21st CCLC program.
Legislation requires that the State award grants only to applicants that will primarily serve students
who attend schools with high concentrations of low-income students. In addition, the State will give
priority to applicants proposing to serve schools identified as Focus Schools or Priority Schools
under the State’s approved ESEA Flexibility. For information on the poverty rates of schools and
the lists of Focus and Priority Schools, go to: http://www.ncpublicschools.org/program-
monitoring/. Note that the list of Title I schools on the website includes the poverty rates of all
public schools in North Carolina.

Attachment 4: Attach a sample one-month programmatic schedule.

H. Programming Offered (Including Summer Component)

In NC, programs must offer activities that focus on reading and/or math. Priority is given to
proposals that have a focus on STEM activities. All others activities offered must support the overall
goal of the 21st CCLC program to increase student academic achievement.



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Each activity selected must be clearly described and supported through research citations and/or
evaluation results in Section IV, Principle 3 of the application. In addition, summer programs must
serve as an extension of the school year program and must adhere to the same guiding principles as
the proposed school year program.

I. Transportation of Students

Applicants must describe how students will travel safely to and from the center and home. For sites
operating on school campuses, this will include information on supervision of students arriving and
departing from the 21st CCLC program. For sites operating off school campuses, information must
be provided as to how students will be transported to the center in a way that makes the program as
accessible to them as if it were on a school campus.

J. Community Outreach

Applicants must describe how the community will be informed about the availability of the 21 st
CCLC program and what information is available for their review including the organization’s
application for the grant. Information must be provided in a format that is understandable and must
be made broadly available to the community.

Attachment 5: Attach samples of communication tools that demonstrate the information
disseminated to the community. (Limit 3)

Section IV: Program Narrative Based on the Principles of Effectiveness

Principle 1: Needs Assessment

A needs assessment will help to identify both the needs of the students and the gaps in services that
are necessary to assist them. Conduct a needs assessment to determine the focus of the grant
proposal. This section should clearly detail the needs that will be addressed by the proposed
program and should include risk factors that place the students in jeopardy of academic failure or
behavioral penalties.

Provide a description of the community and school(s) to be served by citing factors that impact the
educational outcomes of the identified students. This information should come from local
school/community-based data and will assist in determining the program’s mission. These factors
may include, but are not limited to the following:

      poverty rates in the communities to be served;
      percentage or recent growth of Limited English Proficient students and adults;
      reading and math scores;
      educational levels for the identified students and their families;
      trends in EOC and EOG test data;
      school truancy rate;
      juvenile crime rates;
      violent and drug-related offenses;
      short-term suspension or office referral rates;

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       long-term suspension or expulsion data;
       attendance data;
       graduation rates;
       school dropout rate;
       survey results that support program needs;
       interviews with stakeholders; and
       other county, school, or local education agency data.

Applicants should describe how the proposed program is appropriate and how it will successfully
address the needs of the target population. The services to be provided should be closely tied to the
identified needs. Applicants are encouraged to use trend data over a minimum three-year period.
Applicants are advised to identify specific academic needs that can be impacted by the program.

Principle 2: Goals and Objectives

Describe the program goals and corresponding SMART objectives as they relate to the project’s
goals and the State Priorities. A goal is an overarching principle that guides decision-making.
SMART objectives are specific, measurable, attainable, realistic, and timely strategies taken to meet a
goal. SMART objectives should be written to include the following:

       The people whose behaviors knowledge, and/or skills are to be changed as a result of the
        program;
       The intended behavior, knowledge, and/or skill changes that should result from the program
        or activities;
       What tool or device (surveys, tests, data from school or other sources) will be used to
        measure the expected changes;
       What the criteria for success will be; and
       When the expected outcome will occur.

For example, if one of the goals of a program is to help students improve their reading skills, an
objective for that goal might be to increase the percentage of students in the program that move
from scoring below grade level to scoring at grade level on state reading tests each year. The
objective could be measured annually using the state end-of-grade test score data from program
participants. It is best to quantify the objective into a criterion for success. In this case, the criterion
might be to increase the percentage of students in the 21st CCLC program scoring at or above grade
level by 5 percentage points within a given time frame (for example, students scoring at or above
grade level will increase from 21% to 26% by year two of the grant).

Several measurable objectives may be needed to successfully achieve one goal. For example, a
second objective for the goal of helping students improve reading skills might be for students to
report reading more books for pleasure over a period of time.

At least 5 Performance Measures from the State Priorities must be addressed by the proposed
project. At least 3 from NC Priority (1) and at least 1 from NC Priority (2) must be selected.




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NC PRIORITY (1): Participants in the 21st Century Community Learning Center programs will
demonstrate educational and social benefits and exhibit positive behavioral changes.

       Performance Measures:
       1a. The percentage of elementary, middle, or high school 21st CCLC regular program
       participants whose mathematics grades improved from fall to spring.
       1b.The percentage of elementary, middle, or high school 21st CCLC regular program
       participants whose English language arts grades improved from fall to spring.
       1c. The percentage of elementary, middle, or high school 21st CCLC regular program
       participants who improve from not proficient to proficient or above in reading on state
       assessments.
       1d. The percentage of elementary, middle, or high school 21st CCLC regular program
       participants who improve from not proficient to proficient or above in mathematics on state
       assessments.
       1e. The percentage of elementary, middle, or high school 21st CCLC regular program
       participants with teacher-reported improvement in homework completion and class
       participation.
       1f. The percentage of elementary, middle, or high school 21st CCLC regular program
       participants with teacher-reported improvements in student behavior.

NC PRIORITY (2): 21st Century Community Learning Centers will offer high-quality enrichment
opportunities that positively affect student outcomes such as school attendance and academic
performance, and result in decreased disciplinary actions or other adverse behaviors.

       Performance Measures:
       2a. The percentage of 21st CCLC reporting emphasis in at least one core academic area.
       2b. The percentage of 21st CCLC offering enrichment and support activities in other subject
       matter areas.

Principle 3: Research-Based Programs

As defined by ESEA (20 USC, Section 9101(37)), scientifically-based research:
   A. Means research that involves the application of rigorous, systematic, and objective
       procedures to obtain reliable and valid knowledge relevant to education activities and
       programs; and
   B. Includes research that:
           i.  Employs systematic, empirical methods that draw on observation or experiment;
          ii.  Involves rigorous data analyses that are adequate to test the stated hypotheses and
               justify the general conclusions drawn;
         iii.  Relies on measurement or observational method that provide reliable and valid data
               across evaluators and observers, and across studies by the same or different
               investigators;
         iv.   Is evaluated using experimental or quasi-experimental designs in which individuals,
               entities, programs, or activities are assigned to different conditions and with
               appropriate controls to evaluate the effects of the condition of interest, with a
               preference for random-assignment experiments, or other designs to the extent that
               those designs contain within-condition or across-condition controls;



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          v.    Ensures that experimental studies are presented in sufficient detail and clarity to
                allow for replication or, at a minimum, offer the opportunity to build systematically
                on their findings; and
         vi.    Has been accepted by a peer-reviewed journal or approved by a panel of
                independent experts through a comparably rigorous, objective, and scientific review.

Applicants must clearly describe 1) programming that includes a description of activities that were
identified in Section II, Programming Offered; and 2) organizational development that addresses
leadership development, improving program outcomes, building relationships with community
partners, effective communication, program evaluation, and data-collection procedures. The
description must cite current research (i.e., less than ten years old) that supports implementation of
the proposed program or program evaluations that provide evidence that the 21st CCLC program
will improve academic performance and parent involvement or prevent or reduce the risk of drug
use, violence, or disruptive behavior among youth. Program model elements may include
instructional delivery methods, staff/student ratios, time on task, special instructional materials, use
of technology, etc. Describe how you will base your operating structures or activities on these
model programs. Provide references for studies cited.

Principle 4: Program Evaluation

Programs create activities to carry out program objectives. The Program Evaluation determines the
success of achieving the goals and SMART objectives described above. In this section, the emphasis
is on evaluation of program activities. Process evaluations not only inform the implementation
process but also provide evidence to make programmatic changes and refine implementation
strategies in order to achieve project goals. Outcome evaluations determine the overall success of
program activities in achieving program goals and SMART objectives within stated timelines.

Programs may be evaluated formally (e.g., the EOG reading test) at set intervals or more informally
and frequently, as when a teacher assesses the overall verbal reading progress of students.

Use the factors listed below to create an evaluation plan that will serve to continuously improve the
21st CCLC program.

        a. Evaluation Questions: What questions should be answered regarding the program’s
           goal and SMART objectives? What questions should be answered regarding the
           program activities? Examine the relationship between objectives, activities, and expected
           outcomes.
        b. Evaluation Strategy: What tools will be used to determine the effect of program
           implementation strategies? What approach will be taken to find answers to the evaluation
           questions? What are the criteria to assess lessons learned from the program? What
           considerations should be made for grade level differences?
        c. Data: What measurement instruments will be used? How will the baseline be
           established? There should be a combination of quantitative (test scores, attendance, etc.)
           and qualitative (surveys, interviews with parents, students, etc.) data identified. How will
           program staff collect data from the various sites and organizations involved in the
           program? When considering data collection techniques, ensure that the resources are
           sufficient to use the proposed data collection techniques. How will the data be used to
           inform decision-making and refine program implementation strategies?


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        d. Budgeting of resources and staffing for evaluation: The budget submitted should
           reflect sufficient funds to carry out a thorough and useful evaluation.
        e. Dissemination: How will the program’s findings be disseminated to the major
           stakeholders and all individuals with an interest in the program?

Sometimes, external evaluators are used when an organization desires an independent assessment of
the program. Include any proposed work by external evaluators in your evaluation plan.

Note: The use of an external evaluator is not required. If an external evaluator has agreed to serve as
the evaluator for the program, the evaluation plan should identify that individual and/or
organization. A description of the qualifications and responsibilities of the evaluator should also be
included. If the services of an external evaluator are solicited, the amount to be paid to the evaluator
from grant funds cannot exceed three percent (3%) of the grant award amount. If the amount to be
paid exceeds 3% of the grant award, the outstanding balance must come from other resources.

NOTE: If 21st CCLC funds are used to pay for an external evaluation, a copy of the
evaluation must be provided to NCDPI.

Principle 5: Parental and Family Involvement

Section 4205 of the Non-Regulatory Guidance supports the use of 21st CCLC grant funds to provide
programs that promote parental involvement and family literacy to parents of participating students.
Parental/family involvement is critical in promoting not only student successes but also program
success. Research has shown there is a significant link between family involvement and student
achievement (Fan & Chen 2001). Therefore, 21st CCLC programs will be required to provide
meaningful activities to parents of participating students.

Prospective grantees should design a plan for implementing activities for parents of participating
students that may include but are not limited to the following:
     English as a Second Language;
     Literacy and mathematical assistance;
     GED preparation classes;
     High School completion classes;
     Parenting classes; or
     Other family-oriented programs.

Describe the activities that will include parents and families of students who will receive services
from the program. These activities may be aimed at improving the skills of parents or at supporting
the connection between parents and their children’s learning needs. Include initiatives that will
involve parents in their children’s learning, either at home, at programs sponsored by the center, or
elsewhere. Include a description of professional development plans for staff to ensure that parent
involvement plans are implemented with fidelity. Include a description of how parents will be
provided with ongoing communication about the 21st CCLC program.

Attachment 6: Attach sample parent communication tools such as policies, participation
requirements, parent contracts, advertisements/publicity, communication plans, written
plans for outreach strategies to actively engage parents and families. (Limit 3)

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Section V: Fiscal Management

Written fiscal procedures including job descriptions must be in place. The procedures should
emphasize how the sub-grantee segregates duties. As applicable, policies should be in place for
procurement, vendor payment, inventory, payroll time and distribution, cash requests and records
retention. Provide a description of how the accounting/bookkeeping requirements for this grant
will be accomplished and who will be responsible for each part of the process.

NOTE: Audits must be conducted by a certified public accountant (CPA) or by an
accountant certified by the Local Government Commission (LGC) as qualified to audit local
government accounts. The audits shall be performed in accordance with generally accepted
auditing standards (GAAS) and the financial statements must be prepared in conformity
with general accepted accounting principles (GAAP).

Attachment 7: Attach the most recently completed audited financial statement with this
grant application. If no statement is available, applicant must attach a written statement
explaining why audit information is not available.

Section VI: Budget and Sustainability Plan

A. Total Requested Award

All applicants must utilize the Wallace Foundation Out-of-School-Time Cost Calculator when
submitting a request for the annual award amount. The website offers multiple resources to support
program planning and implementation including this online calculator to assist with determining the
costs of high-quality out-of-school time (OST) programs. The calculator may be used online at:
http://www.wallacefoundation.org/cost-of-quality/Pages/default.aspx. Applicants must print and
submit the OST Calculator Results pages to include in the application.

Attachment 8: Attach printed copies of the completed calculation for 1) the School Year
Program; and 2) the Summer Portion of a Year Round Program.

B. Budget Narrative

Grantees must be able to demonstrate the extent to which the costs are reasonable in relation to the
number of students and adults to be served and the correlation to the anticipated results and
benefits. All items included in the proposed budget must clearly relate to activities described in the
program design section of the application. All staff positions, including the Program Director, to be
funded from the grant must be described. An organizational chart for all funded positions must be
provided (Attachment 9). The job description for the Program Director must be provided
(Attachment 3).

It is important to demonstrate how existing school resources such as computer labs, libraries, and
classrooms will be used to carry out program activities. Information about the partners who are
contributing (such as the use of community recreational areas, staff, supplies, etc.) should also be
included in the budget narrative.



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As a general rule, program funds may be used only to cover costs that (1) comply with the approved
grant application and budget; and (2) are reasonable and necessary for the proper and efficient
performance and administration of the grant. A cost is reasonable if, in its nature, it does not exceed
that which would be incurred by a prudent person under the circumstances prevailing at the time
that the decision to incur the cost is made. For more information, go to:
http://www.whitehouse.gov/sites/default/files/omb/assets/agencyinformation_circulars_pdf/a87
_2004.pdf.

C. Proposed Budget

Applicants must use the form FPD 208 (Appendix A) to provide a complete proposed line item
budget for the first year of the program. The budget total must equal the total amount of the
requested award and must be based on the OST Calculator Results.

All budgets must be developed and submitted using the Uniform Chart of Accounts (COA) for
Program Report Code (PRC 110). The COA and code descriptions are available at:
http://dpi.state.nc.us/fbs/finance/reporting/coa2011. Look in the Working Documents section.

NOTE: The proposed budget submitted with the RFP is not the approved budget. Once
grants are awarded, a final budget must be submitted and is subject to review and approval
prior to the release of funds.

Attachment 9: Attach an organizational chart for all other funded positions. Be sure to
indicate the relationships of the Fiscal Agent (Director) and the Program Director to all
other funded staff.

D. Sustainability Plan

Effective partnerships within the community allow for more efficient use of local resources.
Potential partners may include financial institutions and large retail chains. 21 st CCLC program
directors may also seek support from various regional and national foundations such as the National
4-H Council, Boys & Girls Clubs of America, United Way of America, and the YMCA.
Collaboration among diverse partners strengthens the variety of services the community can offer.
For example, a community learning center that partners with a hospital, the local church, and a local
printing company in the community may more readily offer services. For example, these partners
may offer health care information, provide church volunteers for serving snacks, and promote the
program with free copying services.

Include a detailed preliminary plan for continuation of the center after federal funding ends. To
complete the sustainability section:

      Describe the current financial support, including facilities, equipment, supplies and other
       resources, from the applicant’s organization and all partners; and
      Describe how the costs will be covered in years three (3), four (4) and thereafter, including
       sources of funding.

In support of the sustainability plan, programs must maintain accurate records and track data to
demonstrate success. Data that substantiates children’s academic and personal growth resulting from

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the 21st CCLC funded program can illustrate to community members, parents/guardians, and
potential funders the importance of continuing the work beyond the 21st CCLC funding cycles.




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APPLICATION REVIEW AND SELECTION PROCESS

In accordance with the North Carolina State Board of Education (SBE) policy TCS-O-001, all 21st
CCLC applications submitted will go through the following review process.

Initial Login and Screening: Each application is reviewed to determine eligibility. Information is
recorded on a cover sheet to reflect the presence of basic components: proposal sections, applicant
and partner signatures, and other essential items outlined in the 21st CCLC RFP.

Level I Evaluation: The review team is comprised of experienced grant readers from various
professions. Impartial reviewers will evaluate each application based on the proposed activities and
the capability of the applicant to implement the proposed program.

A review team of two reviewers will assess each application utilizing a Rating Rubric. After
proposals are evaluated by individual team members; the review team will discuss each proposal and
come to a consensus on the final rating. Each proposal shall be included in one of the five following
quality bands:
   1. Excellent
   2. Strong
   3. Average
   4. Weak
   5. Unacceptable

Level II Evaluation: Applications recommended for funding by the review team will be reviewed
by a smaller team of reviewers (which may include the division director and review team
chairpersons). These reviewers will use the following criteria and will align applications with specific
funding priorities.

       SBE/NC DPI Priorities: Priorities will be given to applications that propose to implement
        programs with a STEM focus. Additionally, the applicant's attention to agency priorities will
        be taken into consideration. (5 points)
       Geographic Area Needs: The needs of the various geographical areas of the state will be
        considered. Priority will be given to applications that propose to operate programs in
        underserved regions of the state to ensure statewide distribution of funds. (5 points)
       Socioeconomic Needs: Priority will be given to applications that propose to primarily serve
        ESEA Focus and Priority status. (5 points)
       Number of Projects and Total Funding Received: Priority will be given to novice
        applicants. All projects and total amounts funded to each applicant during the current year
        and prior years will be compared with other applicants to insure reasonable distribution of
        funds. (5 points
       Applicant's Prior Performance: For applicants previously awarded 21st CCLC grants, the
        applicant's prior and current performance in related areas will be examined to ensure a high
        probability of success. (5 points)

Level III Evaluation: Using evaluation forms from the review teams, the division director and
other leadership appointed by the appropriate chief officer, jointly determine final selections for
recommendation to the SBE for approval.


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Application Rating Rubric: The rating sheet provides a means for reviewers to objectively review
21st CCLC applications. The rating sheet may also be helpful to applicants to ensure that all
components of the application are included when submitted for review.

As part of Level I Evaluation, two reviewers evaluate each application with a third reader if overall
scores have a discrepancy of 20 or more points. Using the Application Rating Rubric (Appendix G),
individual reviewers rate appropriate sections of the application as follows:

      Leading – 10 points
      Developing – 6 points
      Emerging – 2 points
      Lacking – 0 points

Reviewers provide an overall score for each application. Reviewer ratings are averaged and applied
to the overall score as follows:

    Overall Score               Average of Reviewer Ratings
    Excellent                   100
    Strong                      80-99
    Average                     60-79
    Weak                        40-59
    Unacceptable                0-39

Upon completion of all Level I reviews, applications receiving a score of Excellent or Strong will be
recommended for Level II Evaluation. Level II reviewers will assign additional priority points
according to the following:

      Focus on STEM Initiatives– 5 points
      Serve Focus and/or Priority Schools – 5 points
      Underserved Geographic Area of the State – 5 points
      Novice Applicants – 5 points
      Successful Prior Performance for Returning Grantees (federal compliance, data collection
       and reporting) – 5 points

After completion of Level II Evaluations, priority points will be totaled and added to Level I average
scores for an overall score. Applications will be ranked from highest to lowest numerical scores and
provided to NCDPI leadership along with completed reviewer rating sheets to complete Level III
Evaluations. Reviewers will review outcomes of Level I and Level II evaluations and make final
recommendations to the SBE for approval.

Upon approval from the SBE, the General Contact Person and Fiscal Agent (if different
organization from the General Contact) will be notified via email and written letter through standard
mail.




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                             Appendix A: GLOSSARY OF TERMS

21st Century Community Learning Centers (21st CCLC) - programs that provide significant
expanded learning opportunities for students and their families to assist students in meeting or
exceeding state and local education standards in core academic subjects in a safe and healthy
environment.

Adequate yearly progress (AYP) – a component of the Accountability Profile based on a series of
performance goals that every school, local education agency (LEA), and State must achieve within
specified timeframes in order to meet the 100% proficiency goal established by the federal
Elementary and Secondary Education Act (ESEA).

Center - the physical location where grant-funded services and activities are provided to
participating students and adults.

Community Partner - an organization, other than the sub-grantee, that actively contributes to the
21st CCLC-funded project.

Eligible Students – programs primarily serve students from attending schools in high poverty areas
and those who attend low-performing schools.

Expanded Learning Opportunities - Targeted interventions that can include: teacher articulation
and professional development, student tutoring, application of available technology and resources,
cross curricular project based learning, service learning and internships that occur either within the
confines of regular school day, an extended school day, or in non-school time programming.

Focus Schools – a Title I school in the State that, based on the most recent data available, is
contributing to the achievement gap in the State. The total number of focus schools in a State must
equal at least 10 percent of the Title I schools in the State. A focus school is-

      a school that has the largest within-school gaps between the highest-achieving subgroup or
       subgroups and the lowest-achieving subgroup or subgroups or, at the high school level, has
       the largest within-school gaps in graduation rates; or
      a school that has a subgroup or subgroups with low achievement or, at the high school level,
       low graduation rates.

An SEA must also identify as a focus school a Title I high school with a graduation rate less than 60
percent over a number of years that is not identified as a priority school.

These determinations must be based on the achievement and lack of progress over a number of
years of one or more subgroups of students identified under ESEA section 1111(b)(2)(C)(v)(II) in
terms of proficiency on the statewide assessments that are part of the SEA’s differentiated
recognition, accountability, and support system, combined, or, at the high school level, graduation
rates for one or more subgroups.

Hours of Operation – the number of program hours offered to students participating in 21st CCLC
programming. Hours of operation should be relatively consistent across the school year.


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Recommended program operation is at a minimum 12 hours per week with a minimum
three days per week (including Saturdays).

Instructor(s) – the person or persons employed by a 21st CCLC program to deliver instruction in
reading, English/language arts, and/or mathematics to eligible student(s) enrolled in the 21 st CCLC
program. Instructors may also be referred to as “tutors.”

Local Education Agency (LEA) – local boards of education (commonly referred to as local
school districts).

Local Evaluation – periodic evaluation conducted by local-level 21st CCLC sub-grantees. Findings
must be used to refine, improve, and strengthen the programs and improve performance measures.
Evaluation results must be made public on request.

North Carolina Center for After School Programs (NC CAP) – the advisory board that
considers the thinking and experience of providers, researchers, and other professionals, in North
Carolina and across the country, to determine what high quality programs have in common.
Representing the diversity of North Carolina afterschool programs, NC CAP endorses nine quality
indicators of effective afterschool programs.

Parent(s)/Legal Guardian(s) – refers to the person or persons legally responsible for the
guardianship of the student.

Positive Youth Development – strategies that empower youth to make responsible health
promoting decisions for self and community by teaching and assessing life skills, building self-
efficacy in youth, fostering resiliency, modeling desired behaviors, and developing meaningful
relationships in a sincere, caring, and nurturing environment.

Principles of Effectiveness – standards established by USED to ensure the purpose and intent of
Title IV is met through the design of programs and use of funds (See Appendix D).

Priority Schools – is a school that, based on the most recent data available, has been identified as
among the lowest-performing schools in the State. The total number of priority schools in a State
must be at least five percent of the Title I schools in the State. A priority school is a school among
the lowest five percent of Title I schools in the State based on the achievement of the "all students"
group in terms of proficiency on the statewide assessments that are part of the SEA’s differentiated
recognition, accountability, and support system, combined, and has demonstrated a lack of progress
on those assessments over a number of years in the "all students" group; a Title I-participating or
Title I-eligible high school with a graduation rate less than 60 percent over a number of years; or a
Tier I or Tier II school under the SIG program that is using SIG funds to implement a school
intervention model. Of the 77 schools designated as Priority, 40 schools were identified under the
School Improvement Grant program.

Regular Attendees – refers to students who have attended a 21st CCLC program for at least 30
days (which do not have to be consecutive) during the attendance reporting period.

Regular School Day – refers to a traditional 6.5 hour instructional school day.



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STEM – Science, Technology, Engineering, and Mathematics (STEM) programs inspire and
encourage students by engaging them in hands-on, experiential, inquiry-based, and learner-centered
activities (including engineering design processes) that embrace each STEM component and their
interrelationship not just in theory but in real world practice.

SMART Objectives – Specific (S), Measurable (M), Attainable (A), Realistic (R), and Timely (T)
objectives provide specific and measurable strategies toward achieving stated goals, realistic data
points to inform progress toward stated goals, and mechanisms that track the progress toward and
achievement of stated goals within a given time frame.

Standards for Monitoring – a set of criteria that 21st CCLC programs are required to meet in order
to demonstrate that the programs they provide to students are high quality.

State Assessment – assessment(s) administered by a given state relied upon by the state education
agency (SEA) to meet consolidated reporting requirements under the No Child Left Behind (NCLB)
Act of 2001.

State Education Agency (SEA or State) – the state agency that provides oversight for federal
grants administration is the North Carolina Department of Public Instruction (NCDPI). The State
Superintendent of Schools implements the administrative functions on behalf of the North Carolina
State Board of Education.

Sub-Grantee – agency or entity that is awarded a sub-grant by and is accountable to NCDPI.

The Elementary and Secondary Education Act (ESEA) – the principal federal law affecting
education from kindergarten through high school. ESEA is designed to improve student
achievement and close achievement gaps. States are required to develop challenging academic
standards, to educate all students to 100 percent proficiency by 2014, and to create and implement a
single, statewide accountability system.

Title I – the federal ESEA program that focuses on improving the academic achievement of the
disadvantaged by ensuring that all students have a fair, equal, and significant opportunity to obtain a
high-quality education and reach, at a minimum, proficiency on challenging State academic standards
and State academic assessments.

Tutors – the person or persons employed by a 21st CCLC program to deliver instruction in reading,
English/language arts, and/or mathematics to eligible student(s) enrolled in the provider’s program.
Tutors may also be referred to as “instructors.”




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                   Appendix B: PRIVATE SCHOOLS CONSULTATION FORM

The Office of Management and Budget Circular A-133 Compliance Supplement, Cross Cutting
Section, page 4-84.000-20 states: An SEA, LEA, any other educational service agency (or
consortium of such agencies), or private organization receiving financial assistance under an
applicable program shall provide eligible private school children and their teachers or other
educational personnel with equitable services or other benefits under these programs. Before an
agency or consortium makes any decision that affects the opportunity of eligible private school
children, teachers, and other educational personnel to participate, the agency or consortium shall
engage in timely and meaningful consultation with private school officials.

Please complete the following form related to the involvement of eligible private schools in Title IV,
Part B, 21st CCLC grant activities.

         There are no private schools located within the boundaries of the school district or, in the
         case of a private organization, within the boundaries of the proposed attendance area of the
         21st CCLC program.
         There are private schools located within the boundaries of the school district or, in the case
         of a private organization, within the boundaries of the proposed attendance area of the 21st
         CCLC program and these schools (listed below) were consulted (indicate methods below)
         prior to the development of the Title IV, Part B, 21stCCLC application.

Private school name(s) in your school district:



Method(s) of Contact—Applicant Initiated (check all that apply)
          Letters or facsimile documents
           Meetings
           Documented telephone calls
           E-mail
           Other (please list):

Schools Electing to Receive Services—List the schools that have elected to receive services.

                         PRIVATE SCHOOL                                                      ESTIMATED
       If no private schools have chosen to participate, please list                        ENROLLMENT
                               “NONE.”



Signature of Fiscal Agent                  Signature of Collaborative                    Signature of Collaborative
                                           Partner                                       Partner

Date                                       Date                                          Date
For the current list of conventional non-public schools (i.e., private schools) go to:
http://www.ncdnpe.org/convnonpub.aspx

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                   Appendix C: SAMPLE PARTNERSHIP AGREEMENT

Applicants must develop their own agreements. Failure to submit customized Partnership
Agreement(s) will be an indicator that the required collaboration did not occur. The following
sample is to assist you in the development of your agreements.

                                            Partnership Agreement

The ________________________________ and ________________________________
        (Name of School)                           (Name(s) of Partnering Agencies)

agree to assume and perform the following roles and responsibilities in the administration of the 21st
Century Community Learning Centers program during the 2013-2014 school year. The goal of this
program is to provide a 21st CCLC program of the highest quality for the participating students.

The partnership agreement is comprised of three sections:
 Joint Responsibilities of the Organization and Partnering Agencies
 Responsibilities of the Partnering Agencies

I.      Joint Responsibilities of the Organization and Partnering Agencies (Examples)

1. Ensure that all procedures and regulations for health, fire, safety, pick-ups, parent consents,
   transportation, field trips, food, medical and other emergency procedures, etc. will be clearly listed and
   widely disseminated, and that they will conform to applicable local and state standards.

2. Structure and facilitate meaningful communication between the staff in the 21st CCLC program. Provide
   on-going opportunities for 21st CCLC staff to plan, coordinate, and integrate curricular areas with after-
   school activities.

3. Hold regularly scheduled meetings between the staff of the partnering agencies and school principal, as
   well as other appropriate personnel, to discuss all issues pertaining to the 21st CCLC program. Issues
   would include, but not be limited to, staff performance, effectiveness of program features, student
   development, and other issues of program evaluation.

4. Develop mechanisms and opportunities to communicate on a regular basis with family members of the
   program’s students, including information regarding the afterschool program that is accessible in a public
   space.

5. Recruit, select, and enroll student participants in the 21st CCLC program and disseminate procedural
   information widely.

II.     Responsibilities of the Partnering Agencies (Examples)

1. Communicate and provide information to the organization about the 21st Century CCLC program
   through regularly scheduled meetings or participation on an advisory board.

2. Work cooperatively with the research and evaluation component of the 21st CCLC program.

3. Ensure the respectful treatment of school property, including replacing property damaged or destroyed
   by the volunteer staff of the afterschool program, and keeping the spaces used by the afterschool
   program clean.

4. Ensure that all applicable local and state requirements for volunteer staff clearances are met.


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5. Ensure that volunteer staff is available on-site during program hours trained in first aid, CPR and medical
   emergencies.

6. Provide the lead 21st CCLC agency with all appropriate and requested reports in a timely fashion.



Agreed on this day, __________________________________________, by
                                                    (Month/day/year)


__________________________________                             ____________________________________
(Name of Partnering Agency)                                    (Signature of Fiscal Agent)


_________________________________________________              _______________________________________________________
(Name of Partnering Agency)                                    (Signature of Fiscal Agent)

__________________________________                             ____________________________________
(Name of School District)                                             (Signature of District Superintendent)


 (You may add more signatures as appropriate.)




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                     Appendix D: PRINCIPLES OF EFFECTIVENESS
                   RATIONALE AND EVALUATION OF DESCRIPTIONS

Principle 1: Needs Assessment
Rationale: A needs assessment is the process of gathering information from all stakeholders in order to guide
program development. It is one of the essential tasks in planning to apply for the 21stCCLC grant and must be
completed prior to submitting the application. A needs assessment must identify both the needs of the
students and the gaps in services that are necessary to assist them. The needs assessment should include risk
factors that place the students in jeopardy of academic failure or behavioral penalties. Grantees are encouraged
to build on existing data collection efforts and examine available objective data from a variety of sources,
including law enforcement and public health officials.
Evaluation: The application will be evaluated based on the organization’s ability to provide clear specific
details regarding the analysis of community, school, and student needs from multiple data sources.
Principle 2: Measurable Goals and Objectives
Rationale: Grantees shall develop goals and objectives that permit them to determine the extent to which
programs are effective in increasing academic performance or reducing or preventing drug use, violence, or
disruptive behavior among youth. The goals and objectives must address who is involved; what the desired
outcomes are; how progress will be measured; and when the outcome will occur.
Evaluation: The application will be evaluated based on the organization’s ability to provide measurable goals
and objectives that focus on academic, behavioral, or attitudinal program outcomes, as well as on program
implementation.
Principle 3: Effective Research Based Programs
Rationale: In designing programs, a grant recipient, taking into consideration its needs assessment and
measurable goals and objectives, shall select and implement programs for youth that have demonstrated
effectiveness or promise of effectiveness in improving academic performance and parent involvement or in
preventing or reducing drug use, violence, or disruptive behavior, or other behaviors or attitudes demonstrated
to be precursors to or predictors of drug use or violence. The implementation of research-based programs
will significantly enhance the effectiveness of programs supported with Federal funds. In selecting effective
programs most responsive to their needs, grantees are encouraged to review the breadth of available research
and evaluation literature, and to replicate these programs in a manner consistent with their original design.
Evaluation: The application will be evaluated based on the organization’s ability to demonstrate that
programs will be designed and implemented based on available research that supports the program’s promise
of effectiveness on meeting student, family and community needs identified in the needs assessment.
Principle 4: Program Evaluation
Rationale: Grant recipients must assess their programs and use the information about program outcomes
and fidelity of replication to re-evaluate existing program efforts. Grantees should use their assessment results
to determine whether programs need to be strengthened or improved, and whether program goals and
objectives are reasonable or have already been met and should be revised.
Evaluation: The application will be evaluated based on the organization’s ability to sufficiently describe how
the organization will periodically evaluate programs to assess the progress toward achieving their goals and
objectives, and use the evaluation results to refine, improve, and strengthen their programs, and to refine the
goals and objectives as appropriate.
Principle 5: Parent and Family Involvement
Rationale: Grantees must design and implement activities that will include parents and families of students
who will receive services from the program. The plan to promote parent and family involvement must be
closely aligned to activities of the students participating in the program. Documentation such as policies,
requirements, parent contracts, advertisements and publicity, communication plans, outreach strategies to
enlist parent and family involvement, or other proof of efforts being made to ensure involvement should be
submitted as part of the proposal.
Evaluation: The application will be evaluated based on the organization’s ability to sufficiently describe its
parent and family involvement plan.


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       Appendix E: SAMPLE MEASURABLE GOALS AND SMART OBJECTIVES

State Priority 1.12: The percentage of elementary 21st Century regular program participants with teacher-reported improvements in student behavior.
Goal 1: To facilitate development of and instruction in life skills/character education to increase the prevalence of appropriate and learning centered student
behaviors.
SMART Objectives                Implementation                      Evaluation Tools                                                     Timeline
                                Strategies
5% annual increase in the       -Annual staff dev.                   -Pre/Post Survey of teacher competency                                 -Year 1,2,3,4
incidence of teaching and                                            -Agendas, Meeting Minutes,
assessing life skills during    -Monthly staff                       -Teacher Observation Data Sheets                                       -Monthly
out of school instructional     debrief/retraining as needed         -6 months of student attendance data at 21stCCLC and regular           -Semi annual
time.                                                                school                                                                 -Semi annual
                                                                     -Pre/Post Survey of student competency in applying learned             -Semi annual
                                -Student life skills training        skills
                                                                     -Student projects
Criteria for Success:           Evidence of a reduction in risk taking behaviors that contribute to substance abuse and violence and in increase in support for
                                learning among students.
Expected Outcome:               An increase in the evidence of application of life skills among students, an increase of modeling of life skills among staff,
                                and an increase in learning centered behaviors among students and staff.
10% reduction in                - Student life skills training       -Pre/Post Survey of student competency in applying learned             - Semi annual
regular school student          -Biweekly booster lessons within skills
                                6 weeks of initial instruction
referrals of 21st CCLC          -In school teacher meetings for      -Agendas, Meeting Minutes, -Teacher Observation Data Sheets            - Monthly
students for                    capacity building and                -Agendas, Meeting Minutes
disruptive                      reinforcement                        -6 months of student attendance data at 21stCCLC and regular           - Monthly
behaviors                       -Parent/guardian meetings for        school                                                                 - Monthly
                                capacity building                    -6 months of regular school student referral data                      - Monthly

Criteria for Success:       Evidence of a reduction in regular school referrals of 21st CCLC students.
Expected Outcome:           An increase in the evidence of application of life skills among 21stCCLC students, a reduction in referrals of 21st CCLC students
                            during the regular school day, and an increase in awareness of regular school staff of the impact of 21st CCLC strategies during the
                            regular school day.
State Priority: 1.1 The percentage of elementary 21st Century regular program participants whose mathematics grades improved from fall to spring.
Goal 1: To support grade level mathematics instructional outcomes delivered during the regular school day.
SMART Objectives                Implementation                      Evaluation Tools                                                     Timeline
                                Strategies
10% increase in                 -Communication plan to              -Communication plan with timeline                                    -Year one
collaborations about grade      facilitate collaborations between
level mathematics               in school teachers and 21st
instructional outcomes          CCLC teachers
between regular school and      -Attendance of 21st CCLC staff
out of school teachers          at in school PLC meetings,          -Review of meeting minutes                                           -Monthly
                                -Email and phone
                                communications
                                -Alignment of 21st CCLC             -Email logs, phone logs by 21stCCLC site director                    -As needed at least weekly
                                teacher lesson plans to in school   -21stCCLC lesson alignment to grade level mathematics                -Year 1,2,3,4,
                                grade level mathematics             standards and Title I school grade level mathematics strategies
                                strategies

Criteria for Success            Evidence of increased mathematics competency by 21st CCLC students.
                                Evidence of improved collaborations between regular schoolteachers and 21st CCLC teachers.
Expected Outcome                Increase in communications between feeder schoolteachers and 21st CCLC teachers about strategies to support 21st CCLC student
                                successful mathematics participation and outcomes.
2% increase in 21st CCLC        -21st CCLC teacher training on      -Pre/Post Surveys of teacher competency in applying effective     -Year 1, 2,3,4
student math EOG scores         effective mathematics               mathematics enrichment activities for 21st CCLC students.
                                enrichment activities, resources,   -Site director observation sheets                                 -Biweekly
                                and strategies                      -Weekly 21stCCLC teacher / site director staff meetings           -Meeting minutes/ agenda
                                -21st CCLC teacher delivery of      -21st CCLC formative assessment devices                           -21stCCLC teacher lesson
                                effective mathematics               -21stCCLC student mathematics scores                              plans
                                enrichment, activities, resources,                                                                    -21stCCLC student
                                and strategies,                                                                                       assessments
Criteria for Success            Evidence of increased 21st CCLC teacher competency in delivering mathematics enrichment.
                                Evidence of increased mathematics competency by 21st CCLC students.
Expected Outcome                Increase in mathematics participation, increase in mathematics formative assessment outcomes, and increase in mathematics in school
                                scores and EOG scores by 21st CCLC students.




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                                    Appendix F: BUDGET FORMS

INSTRUCTIONS FOR COMPLETING FORM FPD 208

PAGE 1: APPROVED BUDGET
1. Program Report Code                     Enter the Program Report Code (PRC) that indicates the
                                           Approved Grant Program.
2. Program                                 Enter the program title for the Approved Grant.
                                           For Example, PRC 110 is ESEA Title IV-B.
3. LEA/Grantee Name                        Enter name here.
4. LEA Code/Non-LEA Unit Number            Enter three-digit code assigned to LEA or non-LEA.
5. Project Number                          Eight digits: _ _ _ _ _ _ _ _
                                                          (FY PRC LEA#)
6. Project Approval Date                   For State Agency Use Only.
7. Approved Budget Amount                  The total of your PLANNING ALLOTMENT.
8. Project Period                          Enter the fiscal year Beginning Date and Ending Date of the
                                           project.
9. Account Classification                  Enter Account Description.
10. Account Code                           Enter the PRC - See Number 1 above.
                                           Enter the appropriate Account Codes to be budgeted. Example
                                           Line Item: 3-5200-110-121
11. Approved Budget                        Enter the budget for each Account Code on the form.
12. Signatures for LEA’s Superintendent    An original signature and the date are required.
    or Finance Officer:
PAGE 2: APPROVED BUDGET (Continuation page to be used if necessary. See items 9-11 above).
PAGE 3: SUMMARY OF BUDGETED POSITIONS
1. Account Code                         Enter the eleven digit budget code as outlined in the Uniform
                                        Chart of Accounts (Ex. 3-5200-060-121)
2. Number of Positions                  Number of personnel to be employed.
3. Position Description:                The Uniform Chart of Accounts description. For Example:
                                        Teacher, Supervisor, and Psychologist
4. Percent Assigned To Project          Percent of time each position works in the project. For example:
                                        15 Tutor positions at 100%; 2 Teacher positions at 75%
5. Number of Months Assigned To         Number of months positions are assigned to the project. For
    Project                             example: 15 Teacher positions at 100% (10 Months)
6. Budgeted Dollars                     The estimated yearly salary (not including benefits) for the
                                        identified position. Budgeted dollars should take into consideration
                                        the total number of positions, percent employed, and the months
                                        assigned.




                                                                                             41 | P a g e
     FPD 208
     (R 5/01)
                                       DEPARTMENT OF PUBLIC INSTRUCTION
                                            301 N. WILMINGTON STREET
                                        RALEIGH, NORTH CAROLINA 27601-2825

                                       APPROVED BUDGET

                                       PROGRAM REPORT CODE #

                                        PROGRAM:


Fiscal Agent Name                                                    LEA /Unit Number

Project Number            09-050-XXX                                 Approved Budget Amount

PROJECT PERIOD:           Beginning:                                         Ending:


         ACCOUNT CLASSIFICATION WITH
         DESCRIPTION OF EXPENDITURES                       ACCOUNT CODE                   APPROVED BUDGET
 (i.e., Professional Development – Poverty Workshop)       3-XXXX-050-XXX




Total Grant Funds

     Signature of LEA Superintendent/Finance Officer/Administrator                                 Date

                                Program Administrator                                              Date

 STATE USE ONLY - SIGNATURE INDICATING APPROVAL: ______________________________________




                                                                                                42 | P a g e
      FPD 208
      (R 5/01)




ACCOUNT CLASSIFICATION WITH                          3-XXXX-050-XXX
DESCRIPTION OF EXPENDITURES                          ACCOUNT CODE     APPROVED BUDGET

(i.e. Professional Development – Poverty Workshop)




Total Grant Funds




                                                                            43 | P a g e
FPD 208
(R 5/01)

SUMMARY OF BUDGETED POSITIONS




                                                                      Number of
                                                          Percent       Months
                    Number                              Assigned To   Assigned To
Account Code           of        Position Description     Project       Project           Dollars
                    Positions




*PAR Forms are required for employees who are paid from more than one funding source.
**Certification Statements are required for employees paid 100% from grant funding.


Note: The position description is the general title of the position (e.g., Teacher, Tutor,
Director, etc.). Attach a specific job description for each Position listed above. At a
minimum each job description must include 1) a summary of the position; 2) knowledge
and skills required; 3) essential duties; and 4) qualifications (i.e., education and related work
experience)




                                                                                     44 | P a g e
                                   Appendix G: RESOURCES

Information on NC Schools and Students

      School Performance Data: http://abcs.ncpublicschools.org/abcs/
      List of Title I Schools: http://www.ncpublicschools.org/program-monitoring/
      List of Priority Schools: http://www.ncpublicschools.org/program-
       monitoring/esea/priority/
      List of Focus Schools: http://www.ncpublicschools.org/program-monitoring/esea/focus/

Information on Afterschool Programming

Afterschool Alliance - http://www.afterschoolalliance.org/publications.cfm
The Afterschool Alliance was established in 2000 by the Charles Stewart Mott Foundation, the U.S.
Department of Education, J.C. Penney Company, Inc., the Open Society Institute/The After-School
Corporation, the Entertainment Industry Foundation and the Creative Artists Agency Foundation.
The organization offers a wide array of publications that assist out-of-school time program officials
with the development of high-quality program activities.

Common Core State Standards (CCSS) - www.corestandards.org
The Common Core State Standards provide a consistent, clear understanding of what students are
expected to learn, so teachers and parents know what they need to do to help them. The standards
are designed to be robust and relevant to the real world, reflecting the knowledge and skills that our
young people need for success in college and careers.

iTunes U - http://www.ncpublicschools.org/itunesu/
The iTunes U site is a new tool that teachers, students, and parents can use to download the latest
multimedia education resources, including presentations, professional development videos,
curriculum materials and more.

National Center on Time and Learning - http://www.timeandlearning.org/
The National Center on Time & Learning is dedicated to expanding learning time to improve
student achievement and enable a well-rounded education. The site offers valuable resources
including a newly developed Quality Time Analysis Tool to review expanded learning opportunities
within the school day.

North Carolina Afterschool Professional Development System -
http://nccap.net/about/useful.cfm
Developed through collaborative partners with NC CAP, the system provides an online centralized
database of afterschool training opportunities across the state. The database is searchable by filters
(county, staff level, content area, etc).

North Carolina Arts Council - http://www.ncarts.org/
The NC Arts Council has branches throughout the state and can identify program resources for Arts
Education in your areas.




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North Carolina Center for Afterschool Programs (NC CAP) -
http://nccap.net/about/useful.cfm
NC CAP provides essential resources for developing high-quality afterschool programs including the
Established Standards of Excellence, Afterschool Professional Core Competencies, and
Recommended Standards for After-school Physical Activity.

North Carolina Essential Standards (ES) - http://www.ncpublicschools.org/acre/standards/
The New Essential Standards are written using the Revised Bloom's Taxonomy (RBT). North
Carolina has chosen RBT to help move to the complex thinking expected from 21st Century
graduates. Webinars, tools and resources for understanding and using the RBT will be made
available throughout the winter and spring.

North Carolina Parent Teacher Association (NCPTA) -
http://www.ncpta.org/parent/index.html
The NCPTA offers valuable resources related to parent and community involvement including
helpful parent materials on the Common Core State Standards.

Positive Youth Development - http://www.cdc.gov/healthyyouthhttp://nrepp.samhsa.gov/ and
http://www.wholechildeducation.org/http://aspe.hhs.gov/hsp/positiveyouthdev99/
Several resources exist to address health promoting behaviors among children. These include
resiliency building strategies, social emotional learning strategies, positive youth development
strategies, and health promotion/risk reduction strategies including violence, injury, and substance
abuse prevention health education.

Southwest Educational Development Laboratory -
http://www.sedl.org/expertise/afterschool.html
SEDL is a nonprofit corporation based in Austin, Texas. SEDL is dedicated to solving significant
education problems and improving teaching and learning through research, research-based
resources, and professional development. SEDL offers online resources and tools for effective out-
of-school time program development.

U.S. Department of Education (USED) -
http://www2.ed.gov/programs/21stcclc/resources.html
USED in partnership with SEDL has developed the Afterschool Training Toolkit. The toolkit
provides sample lessons and other resources to support academic enrichment in afterschool
programs.

Wallace Foundation - http://www.wallacefoundation.org
The Wallace Foundation supports and shares effective ideas and practices to improve learning and
enrichment opportunities for children. The website offers multiple resources to support program
planning and implementation including an Out-of-School-Time Cost Calculator. This online
calculator lets you determine the costs of a variety of options for high-quality out-of-school time
(OST) programs. Along with other resources on this site, the calculator can help program officials
make informed decisions so you can plan for high-quality out-of-school time programming.




                                                                                         46 | P a g e
                                                 Appendix H: APPLICATION RATING RUBRIC
                                                               Level I Review




1. The applicant provides a concise executive summary that clearly describes how the design of the program will ensure that program goals are met.

             Leading (10)                             Developing (6)                            Emerging (2)                             Lacking (0)

Applicant provides:                        Applicant provides:                       Applicant provides:                    Applicant:

   A clear and concise overview of the       A somewhat clear and concise             A limited overview of the key         Lacks an overview of the key
    key aspects of the proposed project;       overview of the key aspects of the        aspects of the proposed project;       aspects of the proposed project;
                                               proposed project;
   A summary that clearly frames the                                                   A limited framework for the           Provides a limited view of the
    intent of the proposed project;           A narrative that somewhat clearly         intent of the proposed project;        intent of the proposed project;
                                               frames the intent of the proposed
   A clear description of how the             project;                                 A unclear description of how the      Lacks a description of how the
    proposed project will meet the                                                       proposed project will meet the         proposed project will meet the
    needs of the target population; and       A somewhat clear description of           needs of the target population;        needs of the target population;
                                               how the proposed project will meet        and                                    or
   An illustration of all components          the needs of the target population;
    contained in the proposed project.         and                                      A limited illustration of the         Lacks an illustration of the
                                                                                         components contained in the            components contained in the
                                              An illustration of some                   proposed project.                      proposed project.
                                               components contained in the
                                               proposed project.




                                                                                                                                                    47 | P a g e
2. The applicant provides basic program information to demonstrate program compliance and quality.

             Leading (10)                                Developing (6)                               Emerging (2)                              Lacking (0)

Applicant provides:                          Applicant provides:                           Applicant provides:                      Applicant provides:

   Comprehensive program director              Program Director job description             A general job description for the       Limited to no information about
    job description, with resume and             and resume that includes                      program director with some               the 21stCCLC specific
    rationale includes 21stCCLC specific         21stCCLC specific duties,                     information about the individual’s       qualifications of the program
    duties, knowledge, skills and prior          knowledge and skills required, and            21stCCLC specific qualifications;        director;
    education and experience;                    prior education and experience;
                                                                                              An organizational chart that            An outline or description but
   An organizational chart that                An organizational chart that                  reflects some but not all                lacks an organizational chart of
    indicates the relationships of the           includes a Fiscal and Program                 21stCCLC funded staff;                   21stCCLC funded staff;
    Fiscal and Program Directors to all          Director position and all
    21stCCLC funded staff;                       21stCCLC funded staff;                       A limited overview of a 4 year          A overview that lacks a 4 year
                                                                                               21stCCLC project, including              21stCCLC project, including
   A detailed overview of a 4 year             A somewhat detailed overview of a             summer months, that reflects the         summer months, and does not
    21stCCLC project, including                  4 year 21stCCLC project, including            21stCCLC Principles of                   reflect the 21stCCLC Principles
    summer months, that reflects the             summer months, that reflects the              Effectiveness;                           of Effectiveness;
    21stCCLC Principles of                       21stCCLC Principles of
    Effectiveness;                               Effectiveness;                               Various community partnerships          Limited detail in relation to
                                                                                               and a partnership agreement that         community partnerships;
   Relevant community partners each            Relevant community partnerships               somewhat addresses roles and
    identified with customized                   identified with basic partnership             responsibilities;                       Schedules with insufficient
    partnership agreements clearly               agreements that addresses                                                              information about period of
    defining joint and individual roles          individual roles and responsibilities;       One-month schedules with                 time, activities, or program
    and responsibilities;                                                                      limited information about                design;
                                                One-month schedules for each site             activities and program design;
   Well-organized one-month site                with general information and                                                          Unclear plans for facility
    schedules reflecting high-quality            details about activities and program         Mostly adequate facility                 utilization in relation to scope of
    programs that engage students;               design;                                       considerations in relation to the        program; or
                                                                                               scope of the program; and
   Advantageous facility utilization for       Facility utilization that is sufficient                                               Limited to no description of
    the scope of the program and the             for the scope of the program; and            Some basic information to                community outreach or provides
    student population to be served; and                                                       address community outreach or            samples that are unrelated to
                                                Appropriate community outreach                advertising with some basic              community outreach.
   Detailed community outreach,                 and marketing initiatives with                samples.
    marketing, and advertising initiatives       sample dissemination materials.
    with sample dissemination materials.



                                                                                                                                                             48 | P a g e
3. The applicant provides a narrative description of the needs assessment conducted to determine the proposed program.

             Leading (10)                            Developing (6)                             Emerging (2)                             Lacking (0)
Applicant provides:                       Applicant provides:                       Applicant provides:                      Applicant provides:

   A comprehensive summary of the           A brief summary of the needs of all      A brief summary of the needs of         A summary of needs of that
    needs of all stakeholders including       stakeholders including the school,        that includes some of the                lacks a sufficient description of
    the school, students, and                 students, and community it will           stakeholders such as the school,         the school, students, and
    community it will serve;                  serve;                                    students, or community it will           community it will serve;
                                                                                        serve;
   An analysis that includes specific       An analysis that includes specific                                                A brief analysis that includes
    data sources with a thorough cross-       data sources with some cross-            An analysis from specific data           limited data sources;
    analysis of all key domains               analysis under some of the key            sources with limited
    (perspective, demographic, process,       domains;                                  representation across key               An analysis that lacks
    and outcome);                                                                       domains;                                 disaggregated data or
                                             An analysis of some risk factors                                                   connections to needs of the
   An analysis of at least four risk         that place students in jeopardy of       A limited analysis of risk factors       target population; and
    factors that place students in            academic failure or behavioral            that place students in jeopardy of
    jeopardy of academic failure or           penalties; and                            academic failure or behavioral          An analysis of need that is
    behavioral penalties; and                                                           penalties; and                           lacking in trend data.
                                             A somewhat detailed data analysis
   A detailed data analysis utilizing        utilizing trend data over a              A limited data analysis utilizing
    trend data over a minimum of three        minimum of three years.                   trend data over a minimum of
    years.                                                                              three years.




                                                                                                                                                      49 | P a g e
4. The applicant describes goals and measurable objectives that reflect project goals and State priorities.

             Leading (10)                               Developing (6)                              Emerging (2)                               Lacking (0)

Applicant provides:                          Applicant provides:                         Applicant provides:                      Applicant:

   More than five NC Priority                  Five NC Priority Performance               Identified 5 NC Priority                Identified fewer than 5 NC
    Performance Measures with at least           Measures with 4 from NC Priority            Performance Measures from only           Priority Performance Measures;
    4 from NC Priority 1 and at least 1          1 and 1 from NC Priority 2;                 one category;
    from NC Priority 2;                                                                                                              Lacks objectives and Expected
                                                Objectives and Expected                    Few objectives and Expected              Outcomes that are Specific,
   Objectives and Expected Outcomes             Outcomes that are somewhat                  Outcomes that are Specific,              Measurable, Attainable, Realistic,
    that are clearly Specific, Measurable,       Specific, Measurable, Attainable,           Measurable, Attainable, Realistic,       and Timely;
    Attainable, Realistic, and Timely;           Realistic, and Timely;                      and Timely;
                                                                                                                                     Lacks SMART objectives, NC
   For each stated program goal:               For each stated program goal:              SMART objectives that do not             priorities, clear program goals,
    clearly defined SMART objectives             somewhat clearly defined SMART              align to stated program goals and        implementation strategies, or
    linked to the selected NC priorities         objectives linked to the selected           NC priorities, or do not                 evaluation tools; or
    and stated program goal, with                NC priorities and stated program            correspond to the stated
    corresponding implementation                 goal, with corresponding                    implementation strategies or            Provides program goals and
    strategies, and evaluation tools; and        implementation strategies, and              evaluation tools; and                    SMART objectives that lack a
                                                 evaluation tools; and                                                                focus on reading/math, STEM,
   Program goals and SMART                                                                 Program goals and SMART                  or the 21stCCLC Principles of
    objectives clearly reflect a focus on       Program goals and SMART                     objectives that somewhat reflect a       Effectiveness.
    reading/math, STEM, and the                  objectives clearly reflect a focus on       focus on reading/math, STEM, or
    21stCCLC Principles of                       reading/math, STEM, or the                  the 21stCCLC Principles of
    Effectiveness.                               21stCCLC Principles of                      Effectiveness.
                                                 Effectiveness.




                                                                                                                                                           50 | P a g e
5. The applicant describes proposed programming that is supported by scientifically-based research to meet the needs of the students.

             Leading (10)                              Developing (6)                             Emerging (2)                             Lacking (0)

Applicant provides:                         Applicant provides:                        Applicant provides:                     Applicant provides:

   Detailed program activities that           Detailed program activities that          Program activities that reflect        Listing of program activities that
    clearly reflect a focus on                  somewhat reflect a focus on                either reading/math, a STEM             lack a reflection a reading/math
    reading/math, STEM, and the                 reading/math, STEM, and the                focus, or the 21stCCLC Principles       focus, STEM focus or
    21stCCLC Principles of                      21stCCLC Principles of                     of Effectiveness;                       21stCCLC Principles of
    Effectiveness;                              Effectiveness;                                                                     Effectiveness;
                                                                                          A brief program framework for
   A description for program                  A description for program                  leadership development,                A summary of program
    organization that clearly outlines          organization that includes                 mechanisms for building                 strategies;
    strategies for leadership                   strategies for leadership                  collaborative partnerships,
    development, mechanisms for                 development, mechanisms for                methods of effective                   Limited to no description of
    building collaborative partnerships,        building collaborative partnerships,       communication, procedures for           program implementation
    methods of effective                        methods of effective                       improving program outcomes, a           strategies or program evaluation
    communication, procedures for               communication, procedures for              data collection plan and program        tools; or
    improving program outcomes, a               improving program outcomes, a              evaluation procedures;
    data collection plan and program            data collection plan and program                                                  Limited evidence to support
    evaluation procedures;                      evaluation procedures;                    Brief descriptions of research-         how program activities and
                                                                                           based program implementation            strategies will impact academic
   Citations of scientifically-based          Citations of scientifically-based          strategies or program evaluation        performance and behavior.
    research that is less than 10 years         research and links to either               activities; and
    old, and supports either program            program implementation or
    implementation or program                   program evaluation activities; and        A summary of how indicated
    evaluation activities; and                                                             research-based activities and
                                               A somewhat clear description of            strategies intend to impact
   A clear description of how each             how each indicated research-based          academic performance,
    indicated research-based program            program activity and strategy              parent/family engagement or
    activity and strategy intends to            intends to improve academic                student behaviors.
    improve academic performance,               performance, engage
    engage parents/families, or reduce          parents/families, or reduce risky or
    risky or disruptive behaviors such as       disruptive behaviors such as
    substance abuse and violence.               substance abuse and violence.




                                                                                                                                                        51 | P a g e
6. The applicant provides a description of the program evaluation to determine success of achieving goals.

             Leading (10)                              Developing (6)                              Emerging (2)                              Lacking (0)

Applicant provides:                         Applicant provides:                        Applicant provides:                       Applicant provides:

   A detailed evaluation process of           A somewhat detailed evaluation            Some program goals and some              Insufficient program goals and
    assessing effective program goals           process of assessing effective             SMART objectives are used in the          SMART objectives that are tied
    and SMART objectives that creates           program goals and SMART                    evaluation process, but more              to the evaluation process and
    an environment for continued                objectives that creates an                 detail or relevance is needed in          program effectiveness;
    student growth;                             environment for continued student          order to enhance program
                                                growth;                                    effectiveness;                           Program activities that are do not
   Program activities that clearly                                                                                                  reflect student’s needs, staffing,
    support goals and SMART                    Program activities that somewhat          Program activities that are limited       and budget considerations;
    objectives with consideration of            support goals and SMART                    in supporting the goals and
    student’s needs, staffing, and budget       objectives with consideration of           SMART objectives with                    Data collections that lack
    considerations;                             student’s needs, staffing, and             consideration of student’s needs,         reference to the overall program
                                                budget considerations;                     staffing, and budget                      goals and SMART objectives as
   Detailed quantitative and qualitative                                                  considerations;                           included in the application;
    data collections that pertain to the       Sufficient quantitative and
    overall program goals and SMART             qualitative data collections that         Limited quantitative and                 Indicated Criteria for Success
    objectives as included in the               pertain to the overall program goals       qualitative data collections that         and Expected Outcomes that
    application;                                and SMART objectives as included           pertain to the overall program            lack connection to the project
                                                in the application;                        goals and SMART objectives as             goals and objectives; or
   Indicated Criteria for Success and                                                     included in the application;
    Expected Outcomes that clearly             Indicated Criteria for Success and                                                  Narrative that lacks methods to
    inform project goals and objectives;        Expected Outcomes that                    Indicated Criteria for Success and        share program evaluation results
    and                                         somewhat inform project goals and          Expected Outcomes that are                with parents, community
                                                objectives; and                            linked to the project goals and           partners, and multiple
   Comprehensive methods to share                                                         objectives; and                           stakeholders.
    program evaluation results with            Somewhat detailed methods to
    parents, community partners, and            share program evaluation results          Limited methods to share
    multiple stakeholders.                      with parents, community partners,          program evaluation results with
                                                and multiple stakeholders.                 parents, community partners, and
                                                                                           multiple stakeholders.




                                                                                                                                                         52 | P a g e
7. The applicant provides a plan to engage parents and families of the students served in the program.

              Leading (10)                             Developing (6)                              Emerging (2)                             Lacking (0)
Applicant provides:                         Applicant provides:                         Applicant provides:                     Applicant provides:

   A comprehensive plan for involving         A plan for involving parents and           A limited plan for parent              A description for involving
    parents and families aligned to the         families aligned to the activities of       involvement with some alignment         parents and families that lacks
    activities of the participating             the participating students, needs of        to the needs of the school and          alignment to the needs
    students, needs of the school and           the school and community as                 community as described in the           assessment;
    community as described in the               described in the needs assessment;          needs assessment;
    needs assessment;                                                                                                              A plan with activities that lack a
                                               A general description of skill             A brief description of activities       focus on the academic needs of
   A detailed description of specific          building activities that address            for a parents that somewhat focus       students;
    skill building activities to increase       literacy and mathematics;                   on academic needs;
    parent empowerment including                                                                                                   A reference to parent/family
    workshops on literacy and                  Proposed parent /family activities         A brief description of                  workshops that is lacking;
    mathematics;                                and workshops to increase the               parent/family workshops that will
                                                likelihood of participation;                be offered during the year;            No description of staff
   Proposed activities and workshops                                                                                               professional development plans
    at times and locations that                A staff professional development           A limited description of                related to parent/family
    accommodate parent /family                  that supports the implementation            professional development plans          involvement; or
    schedules to increase the likelihood        of the parent /family involvement           related to parent /family
    of participation;                           plan; and                                   involvement; and                       A communication plan for
                                                                                                                                    parents/families with insufficient
   A comprehensive staff professional         A brief plan for periodic                  A communication plan to engage          detail.
    development plan that supports the          communication with                          parents/families.
    implementation of a parent/family           parents/families.
    involvement plan; and

   Detailed plan for ongoing and
    regular communication with
    parents/families that increases
    likelihood of engagement.




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8. The applicant describes sound fiscal management processes and procedures sufficient to meet all requirements of federal grants.

             Leading (10)                               Developing (6)                            Emerging (2)                             Lacking (0)
Applicant provides:                          Applicant provides:                      Applicant provides:                      Applicant provides:

   Written policies that demonstrate           Written policies that describe          Brief narrative that somewhat           Limited narrative to describe
    accountability for procurement,              general procedures for fiscal            describe general procedures for          general procedures for fiscal
    vendor payment, inventory, payroll           accountability;                          fiscal accountability;                   accountability
    time and distribution, cash requests,
    and records retention;                      General written procedures that         Brief written procedures that           Little to no written procedures
                                                 address how duties are segregated;       somewhat address how duties are          that address how duties are
   Clearly written fiscal procedures that                                                segregated;                              segregated;
    clearly emphasize how duties are            A general narrative of accounting
    segregated;                                  and bookkeeping requirements;           A brief narrative of accounting or      Little to no narrative of
                                                 and                                      bookkeeping requirements; and            accounting or bookkeeping
   A concise narrative of how the                                                                                                 requirements; and
    accounting and bookkeeping                  An audited financial statement          An audited financial statement or
    requirements of this grant will be           completed by a CPA or an                 a statement that addresses why no       No audited financial statement
    accomplished and who will be                 accountant with LGC certification        audit information is available.          or a statement that does not
    responsible for each part of the             or a statement that addresses why                                                 address why audit information is
    process; and                                 no audit information is available.                                                unavailable.

   An audited financial statement
    completed by a CPA or an
    accountant with LGC certification
    that demonstrates fiscal soundness
    or a statement that sufficiently
    addresses why no audit information
    is available.




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9. The applicant includes a budget with sufficient funds and descriptions needed to support the scope of the proposed program.

             Leading (10)                               Developing (6)                               Emerging (2)                              Lacking (0)
Applicant provides:                          Applicant provides:                         Applicant provides:                       Applicant provides:

   A detailed budget narrative that            A somewhat detailed budget                 A limited budget narrative that          Narrative with insufficient
    clearly aligns to activities proposed        narrative that aligns to activities         identifies some of the activities         information related to proposed
    for program and reflects a total first       proposed for program, reflects the          proposed for the program and              budget activities;
    year budget aligned to the requested         OST Calculator and reflects the             includes a first year budget;
    award using the OST Calculator;              total first year budget requested;                                                   A description of costs that lacks
                                                                                            A limited description of costs that       a reasonable and necessary
   A detailed description of costs that        A somewhat detailed description of          are somewhat reasonable and               relation to the number of
    sufficiently demonstrate that all            costs that are somewhat reasonable          necessary in relation to the              students and adults to be served;
    costs are reasonable and necessary           and necessary in relation to the            number of students and adults to
    in relation to the number of                 number of students and adults to            be served;                               A first year budget that neither
    students and adults to be served;            be served;                                                                            reflects the range of funding nor
                                                                                            A first year budget total that            supports project goals and
   A first year budget total that ranges       A first year budget total that ranges       ranges from $100,000 to $400,000          objectives;
    from $100,000 to $400,000, and               from $100,000 to $400,000, and              but provides limited support for
    supports the project goals and               somewhat supports the project               project goals and objectives;            No budget codes from the DPI
    outcomes;                                    goals and outcomes;                                                                   Chart of Accounts with
                                                                                            Some budget codes from the DPI            expenditures that do not reflect
   Appropriate budget codes from the           Some budget codes from the DPI              Chart of Accounts with                    federal and State guidelines; or
    DPI Chart of Accounts that reflect           Chart of Accounts with                      expenditures that do not reflect
    federal and State fiscal guidelines;         expenditures that reflect federal           federal and State guidelines; and        A budget narrative and budget
    and                                          and State guidelines; and                                                             that do not describe the use of
                                                                                            A budget narrative and budget             existing resources and partners
   A budget narrative and budget that          A budget narrative and budget that          that indicate existing resources          in support of the proposed
    detail how existing resources and            somewhat reflect how existing               and partners will support the             21stCCLC project.
    partners will support the proposed           resources and partners will support         proposed 21stCCLC project.
    21stCCLC project.                            the proposed 21stCCLC project.




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10. The applicant provided a plan that demonstrates likelihood for sustaining the 21st CCLC program beyond the grant period.

             Leading (10)                             Developing (6)                            Emerging (2)                                Lacking (0)

Applicant provides:                        Applicant provides:                       Applicant provides:                        Applicant provides:

   A detailed plan that seeks support        A somewhat detailed plan that            A plan that illustrates to                A plan with little to no emphasis
    from community members and                 seeks support from community              community members and                      on the importance of continuing
    potential funders for program              members and potential funders for         potential funders the importance           the program after grant funding
    continuation after grant funding has       program continuation after grant          of program continuation after              has ended;
    ended;                                     funding has ended;                        grant funding has ended but plan
                                                                                         lacks specificity;                        A description that lacks how
   A detailed description of how             A somewhat detailed description of                                                   record keeping, data collection,
    record keeping, data collection, and       how record keeping, data                 A limited description of how               and student growth will be used
    student growth will be used to build       collection, and student growth will       record keeping, data collection,           to build sustainability beyond the
    sustainability beyond the funded           be used to build sustainability           and student growth will be used            funded project; or
    project; and                               beyond the funded project; and            to build sustainability beyond the
                                                                                         funded project; and                       A description that lacks
   A comprehensive description that          A general description that explains                                                  explanation of how costs will be
    explains how costs will be covered         how costs will be covered in years       A brief description with non-              covered in years (3) and (4).
    in years three (3) – four (4) and          (3) – (4) and beyond.                     specific information about how
    beyond.                                                                              costs will be covered in years (3) –
                                                                                         (4) and beyond.




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                     Appendix I: APPLICATION PACKAGE CHECKLIST
In order for an application to be considered, it must contain all of the sections and forms requested.
The checklist may be used to ensure that all sections of the proposal have been addressed.

                  Application Content                                      Format
      Assurances                                   Signed/dated form

      Debarment Certification                      Signed/dated form

      Criminal Background Check Certification      Signed/dated form

      Executive Summary                            No more than 3 page narrative

      Basic Program Information                    Checkboxes, narratives

      Needs Assessment                             Narrative, graphs, charts

      Measurable Goals and Objectives              Table, narrative

      Effective Research-Based Programs            Narrative with research citations and evaluation results

      Program Evaluation                           Narrative

      Parent and Family Engagement                 Narrative

      Fiscal Management                            Narrative

      Budget and Sustainability Plan               Narratives, budget forms FPD 208

      Private Schools Consultation                 Attachment 1

      Partnership Agreement(s)                     Attachment 2

      Program Director Job Description, Resume     Attachment 3
      and Explanation
      One-month Programmatic Schedule (for each    Attachment 4
      site)
      Sample Community Outreach Materials          Attachment 5
      (Limit 3)
      Sample Parent Engagement Communication       Attachment 6
      Tools (Limit 3)
      Current Audited Financial Statement          Attachment 7

      OST Calculator Results                       Attachment 8

      Organizational Chart of Funded Positions     Attachment 9

      CD-Rom of Application Package                CD-Rom in portable document format (PDF)




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