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					                    INSTRUCTIONS
     Instructions for this application can be found as a
  separate PDF document found on the GSRP website at:
                   www.michigan.gov/gsrp

              APPLICATION NAVIGATION
Go to:
                                              THE GREAT START READINESS PROGRAM (GSRP)
                                                2012-2013 COMPETITIVE GRANT PROPOSAL


                                                                        RUBRIC
Instructions: This screen is "Read Only"; however, it may be printed for reference.
                                                                    Overall Application




                                                                                                                                                                   Scor mended
Incomplete Application, not Eligible                                              Recommended for Funding with
           for Funding.                   Significant Revisions Needed.                Minor Revisions.               Highly Recommended for Funding.




                                                                                                                                                                        m
              (0 points)                              (1 point)                               (3 points)                             (5 points)




                                                                                                                                                                       e
                                                                                                                                                                   Reco
The proposal:                        The proposal:                        The proposal:                               The proposal:
Are there concerns with the application or inconsistencies with the information provided?




                                                                       Cover Page
Has the applicant been operating a child development program for three or more years?
  Applicant has not been operating a                                                                                    Applicant has been operating a
  child development program for                                                                                         child development program for
  three or more years.                                                                                                  three or more years.
Is the applicant a Project ReImagine School District?
   Applicant is not a Project                                                                                           Applicant is a Project ReImagine
   ReImagine school district.                                                                                           school district.
Does the applicant have a plan for providing Supplemental Child Care for children who will attend the program?
  Applicant does not have a plan for                                                                                    Applicant has a plan for providing
  providing supplementary child care.                                                                                   supplementary child care.
                                                                         Narrative
Item 1 - Describe the process used to locate and recruit eligible children:
Does not provide information about   Provides minimal information about         Provides a clear and complete         Includes all information from the box to
the procedure(s) for recruiting      the procedure(s) for recruiting children   description of the procedure(s) for   the left AND includes information on
children.                            OR the procedure(s) are not likely to      recruiting children INCLUDING the     how the program collaborates with
                                     be successful.                             timeline for recruitment.             other local preschool programs.


                                                                  Reviewers Justification




Item 2 - Describe how children's eligibility will be determined:
Does not provide information about    Provides minimal information about        Provides a clear and complete         Provides a clear and complete
the procedure(s) for determining      the procedure(s) for determining          description of the procedure(s) for   description of the procedure(s) for
children’s eligibility.               children’s eligibility.                   determining children’s eligibility.   determining children’s eligibility,
                                                                                                                      including a clear description of a family-
                                                                                                                      friendly application and interview
                                                                                                                      process.
                                                                  Reviewers Justification




Item 3 - Describe the system that will be implemented to ensure that there is documentation of each child’s eligibility status and prioritization for
enrollment:
Does not describe the system to        Provides minimal description of the     Provides a description of the system Provides a clear and complete
document how recruitment, eligibility, system for documentation of eligibility for documentation of eligibility and description of a system for
and prioritization will be documented. or prioritization OR describes a poorly prioritization with some detail.     documentation of eligibility and
                                       organized process system.                                                    prioritization AND includes how
                                                                                                                    confidentiality will be ensured.
                                                                  Reviewers Justification




                                                                                    2
                                                THE GREAT START READINESS PROGRAM (GSRP)
                                                  2012-2013 COMPETITIVE GRANT PROPOSAL


                                                                            RUBRIC
Instructions: This screen is "Read Only"; however, it may be printed for reference.
                                                                    Overall Application




                                                                                                                                                                     Scor mended
Incomplete Application, not Eligible                                                  Recommended for Funding with
           for Funding.                     Significant Revisions Needed.                  Minor Revisions.                Highly Recommended for Funding.




                                                                                                                                                                          m
              (0 points)                                (1 point)                                 (3 points)                             (5 points)




                                                                                                                                                                         e
                                                                                                                                                                     Reco
The proposal:                        The proposal:                                  The proposal:                          The proposal:
Item 4 - Describe the program’s philosophy of early childhood education:
Does not describe the program’s      Provides a vague Philosophy                    Provides a Philosophy Statement but    Provides a clear Philosophy Statement
philosophy of early childhood        Statement.                                     does not address how the philosophy    of early childhood education, including
education.                                                                          is utilized in making program          how the philosophy is utilized as the
                                                                                    decisions.                             basis for making program decisions
                                                                                                                           and establishing program goals and
                                                                                                                           objectives.


                                                                     Reviewers Justification




Item 5 - Report a comprehensive, standardized developmental screening tool:
Reports the use of a screening tool  Reports the use of a screening tool not Reports the use of a screening tool not Reports the use of a screening tool
that is not included on the list of  on the list of acceptable tools AND     on the list of acceptable tools AND     that is included on the list of
acceptable tools AND does not        describes why the applicant thinks the describes why the applicant thinks the acceptable tools.
describe why the tool is acceptable. tool is acceptable, but does NOT        tool is acceptable AND includes
                                     include information on research         information on research related to the
                                     related to the tool.                    tool.
                                                                     Reviewers Justification




Item 6 - Report a research-based, comprehensive curriculum or model/approach:
Reports the use of a curriculum or     Reports the use of a curriculum or     Reports the use of a curriculum or           Reports the use of a curriculum or
model/approach that is not included on model/approach not on the list of      model/approach not on the list of            model/approach that is included on the
the list of acceptable tools AND does acceptable tools AND describes why acceptable tools AND describes why                list of acceptable tools.
not describe why it is acceptable.     the applicant thinks the tool is       the applicant thinks the tool is
                                       acceptable, but does NOT include       acceptable AND includes information
                                       information on research related to the on research related to the tool.
                                       tool.
                                                                     Reviewers Justification




Item 7 - Report a comprehensive ongoing child assessment tool:
Reports the use of a child assessment Reports the use of a child assessment         Reports the use of a child assessment Reports the use of a child assessment
tool that is not included on the list of tool not on the list of acceptable tools   tool not on the list of acceptable tools tool that is included on the list of
acceptable tools AND does not            AND describes why the applicant            AND describes why the applicant          acceptable tools.
describe why the tool is acceptable.     thinks the tool is acceptable, but does    thinks the tool is acceptable AND
                                         NOT include information on research        includes information on research
                                         related to the tool.                       related to the tool.

                                                                     Reviewers Justification




                                                                                        3
                                             THE GREAT START READINESS PROGRAM (GSRP)
                                               2012-2013 COMPETITIVE GRANT PROPOSAL


                                                                        RUBRIC
Instructions: This screen is "Read Only"; however, it may be printed for reference.
                                                                    Overall Application




                                                                                                                                                                 Scor mended
Incomplete Application, not Eligible                                           Recommended for Funding with
           for Funding.                  Significant Revisions Needed.              Minor Revisions.                  Highly Recommended for Funding.




                                                                                                                                                                      m
              (0 points)                             (1 point)                             (3 points)                                (5 points)




                                                                                                                                                                     e
                                                                                                                                                                 Reco
The proposal:                      The proposal:                      The proposal:                          The proposal:
Item 8 - For Classroom-Based (Center-Based) programs, provide a sample Daily Routine that includes all required parts of the day:
Does not include a sample Daily    Includes an incomplete or vague    Includes a detailed sample Daily       Includes a detailed sample Daily
Routine.                           sample Daily Routine.              Routine that provides for all required Routine that provides ample time for
                                                                      portions of a preschool session.       Free-Choice Time, alternates busy
                                                                                                             and quiet and child-initiated and adult-
                                                                                                             initiated activities; and includes time
                                                                                                             for children to plan immediately before
                                                                                                             Free-Choice Time and reflect on child-
                                                                                                             initiated activities immediately after
                                                                                                             Free-Choice Time.

                                                                 Reviewers Justification




Item 9 - For Classroom-Based (Center-Based) programs, describe policies and procedures for home visits and formal parent conferences:
Does not address home visits and   Describes the duration and number of Includes all information from the box to Includes all information from the box to
parent conferences.                planned home visits and formal parent the left AND refers to policies and     the left AND describes effective
                                   conferences.                          procedures for home visits and formal policies and procedures for home
                                                                         parent conferences.                     visits and formal parent conferences.

                                                                 Reviewers Justification




Item 10 - For Home-Based programs, describe home visits:
Does not include a description of a Includes a vague description of a        Describes a home visit, including        Describes a home visit, including all of
home visit.                         home visit.                              number of visits planned, the duration   the elements to the left, AND indicates
                                                                             of the visit, and with whom the visits   how planning for individual children
                                                                             will be conducted.                       will be accomplished.
                                                                 Reviewers Justification




Item 11 - For Home-Based programs, describe cluster activities:
Does not include a description of Includes a vague description of cluster Describes the duration and number of Describes the duration and number of
cluster activities.               activities.                             planned cluster activities.          planned cluster activities, AND how
                                                                                                               families will be involved in planning
                                                                                                               the cluster activities.
                                                                 Reviewers Justification




Item 12 - How will parents be engaged in the program activities?
Does not describe efforts to engage      Suggests limited ways in which       Suggests multiple ways parents can      Suggests multiple ways parents can
parents in the activities of the program parents can be engage in the program become engaged in the program or        become engaged in the program or
or activities with children.             or activities with children.         activities with children.               activities with children; being mindful
                                                                                                                      of varying schedules, abilities, and
                                                                                                                      strengths.
                                                                 Reviewers Justification




                                                                                 4
                                               THE GREAT START READINESS PROGRAM (GSRP)
                                                 2012-2013 COMPETITIVE GRANT PROPOSAL


                                                                           RUBRIC
Instructions: This screen is "Read Only"; however, it may be printed for reference.
                                                                    Overall Application




                                                                                                                                                                    Scor mended
Incomplete Application, not Eligible                                                Recommended for Funding with
           for Funding.                     Significant Revisions Needed.                Minor Revisions.                  Highly Recommended for Funding.




                                                                                                                                                                         m
              (0 points)                                (1 point)                               (3 points)                               (5 points)




                                                                                                                                                                        e
                                                                                                                                                                    Reco
The proposal:                          The proposal:                          The proposal:                               The proposal:
Item 13 - How will parents' participation on the Advisory Committee be ensured?
Does not indicate GSRP parents will    Indicates parents will be represented Describes a variety of ways parents          Describes a clear plan with multiple
be represented on the Advisory         on the Advisory Committee, but does will be encouraged to join the Advisory        ways parents will be encouraged to
Committee.                             not describe how they will be          Committee and some plans to support         join the Advisory Committee,
                                       supported to participate or what their their participation. Does not clearly       examples of support for their
                                       role will be.                          identify parents as decision makers.        participation, and an orientation to
                                                                                                                          decision making as an Advisory
                                                                                                                          Committee member. Includes plans to
                                                                                                                          vary event/meeting times in
                                                                                                                          recognition of varied schedules.
                                                                    Reviewers Justification




Item 14 - Describe the role and responsibilities of the Early Childhood Specialist (ECS) in your program:
NOTE: The ECS must not also be a lead teacher in this GSRP program.
Does not describe the role of the Early Provides a vague description of the       Describes the role and responsibilities Clearly describes the role and
Childhood Specialist.                   role of the Early Childhood Specialist.   of the Early Childhood Specialist.      responsibilities of the Early Childhood
                                                                                                                          Specialist and a plan for how the ECS
                                                                                                                          will be actively involved with each
                                                                                                                          teaching team.
                                                                    Reviewers Justification




Item 15 - How will the effectiveness of the teaching team be evaluated as it relates to the program?
Does not include a description of how Provides a vague description of how Describes how teaching team                     Provides a clear process for the Early
teaching team effectiveness will be   teaching team effectiveness will be   effectiveness will be evaluated with          Childhood Specialist to evaluate
evaluated.                            evaluated.                            the Program Quality Assessment                teaching team effectiveness using the
                                                                            (PQA) Form A.                                 PQA Form A, which includes
                                                                                                                          information as to the frequency of the
                                                                                                                          use of the PQA and how other data
                                                                                                                          will be utilized.
                                                                    Reviewers Justification




Item 16 - Describe how the data from the PQA [or other tool(s) for Home-Based programs], the child assessment tool, and other data sources will
be collected and used to make decisions about the program.
Describes a decision-making process Provides a vague description of how Provides a clear description of how  Provides a description of everything in
that is not based on data.           data is collected and used.         data from the appropriate tools are the box to the left and describes the
                                                                         collected and used to set goals for members of the team that will use the
                                                                         continuous quality improvement.     data, who will lead the team and how
                                                                                                             the team will do its work and
                                                                                                             communicate its decisions to others.
                                                                    Reviewers Justification




                                                                                      5
                                             THE GREAT START READINESS PROGRAM (GSRP)
                                               2012-2013 COMPETITIVE GRANT PROPOSAL


                                                                       RUBRIC
Instructions: This screen is "Read Only"; however, it may be printed for reference.
                                                                    Overall Application




                                                                                                                                                          Scor mended
Incomplete Application, not Eligible                                           Recommended for Funding with
           for Funding.                  Significant Revisions Needed.              Minor Revisions.                Highly Recommended for Funding.




                                                                                                                                                               m
              (0 points)                             (1 point)                             (3 points)                            (5 points)




                                                                                                                                                              e
                                                                                                                                                          Reco
The proposal:                           The proposal:                         The proposal:                            The proposal:
Item 17 - How will staff receive training in a selected screening tool, curriculum, child assessment tool, program requirements, PQA, and the Early
Childhood Standards of Quality for Prekindergarten ?
Does not provide a plan for staff to be Describes a vague plan for providing Describes a plan for training on some Describes a plan for training on all
trained on the selected tools.          staff with training on the selected   tools OR describes training that will be tools to be completed before the
                                        tools.                                completed after the program begins.      program begins.


                                                                 Reviewers Justification




                                                                                 6
IM-02-23-IE Rev. 3/12                                                   Michigan Department of Education
AUTHORITY: State School Aid Bill, Section 32d.                              OFFICE OF GREAT START                           Direct questions regarding
COMPLETION: Voluntary. (Consideration for                     EARLY CHILDHOOD EDUCATION AND FAMILY SERVICES                 this form to (517) 241-9133.
  funding will not be possible if form is not filed.                 P.O. Box 30008, Lansing, Michigan 48909


                                                       THE GREAT START READINESS PROGRAM (GSRP)
                                                         2012-2013 COMPETITIVE GRANT PROPOSAL


                                   Name of Agency/Organization                                  Federal ID Number          Area Code & Phone Number


      APPLICANT
                                   Address                             City                     Zip Code                   County



                                   Sir Title           First Name      Last Name                Area Code & Phone Number   Fax Number


        CONTACT
        PERSON                     Email Address of Contact Person



                                   Sir Title           First Name      Last Name                Area Code & Phone Number   Fax Number

          ISD
        CONTACT
                                   Email Address of Contact Person
        PERSON



Note: Lines 25, 26, and 27 will calculate automatically when the Project Fact Sheet is completed.

                                                                                        0 PART-DAY SLOTS AT $3,400                                         $0
    APPLICATION
      REQUEST                                                                             FULL-DAY SLOTS AT $6,800                                         $0

                                                                                           FOR A TOTAL REQUEST OF                                          $0

HAS BEEN OPERATING A CHILD DEVELOPMENT PROGRAM FOR THREE OR MORE YEARS?
(YES/NO)



IS A PROJECT REIMAGINE SCHOOL DISTRICT? (YES/NO)




DOES HAVE A PLAN FOR PROVIDING SUPPLEMENTARY CHILD CARE FOR CHILDREN WHO
WILL ATTEND THE PROGRAM? (YES/NO)

PLEASE COMPLETE THE INFORMATION REQUESTED USING THIS APPLICATION ONLY. Information is taken from this
application and entered into a database for processing. DO NOT SUBMIT applications with attachments or with answers stating
"see attachments." Non-compliant applications will not be accepted and will be returned to the applicant without review.


ASSURANCES AND CERTIFICATION: By submitting this Assurance and Certification statement, the applicant certifies that it
will agree to perform all actions and support all intentions stated in the Assurances and Certifications and will comply with all
state and federal regulations and requirements pertaining to this program. The applicant certifies further that the information
submitted on this application is true and correct.

Name of Authorized Official                                                        Area Code & Phone Number                Date




SUBMITTAL INSTRUCTIONS: Please submit application via email to mde-gsrp@michigan.gov.
                           THE GREAT START READINESS PROGRAM (GSRP)
                             2012-2013 COMPETITIVE GRANT PROPOSAL



                                      ASSURANCES AND CERTIFICATIONS
ASSURANCES AND CERTIFICATIONS
ASSURANCE CONCERNING COMPLIANCE WITH ALL REQUIREMENTS OF THIS GRANT

Grantees agree to comply with all applicable requirements of State statutes, Federal laws, executive orders,
regulations, policies, and award conditions governing this program. Grantees understand and agree if they
materially fail to comply with the terms and conditions of the grant award, the Michigan Department of Education
(MDE) may withhold funds otherwise due to the grantee from this grant program, any other federal grant
programs, or the State School Aid Act of 1979 as amended, until the grantee comes into compliance, or the matter
has been adjudicated and the amount disallowed has been recaptured (forfeited). MDE may withhold up to 100
percent of any payment based on a monitoring finding, audit finding, or pending final report.

ASSURANCE CONCERNING MATERIALS DEVELOPED WITH FUNDS AWARDED UNDER THIS GRANT

The grantee assures the following statement will be included on any publication or project materials developed with
funds awarded under this program, including reports, films, brochures, and flyers: “These materials were developed
under a grant awarded by the Michigan Department of Education.”

NONDISCRIMINATION UNDER FEDERALLY- AND STATE-ASSISTED PROGRAM'S CERTIFICATIONS

The applicant hereby agrees that it will comply with all federal and Michigan laws and regulations prohibiting
discrimination. In accordance therewith, no person, on the basis of race, color, religion, national origin or
ancestry, age, sex, marital status or handicap, shall be discriminated against, excluded from participation in,
denied the benefits of, or otherwise be subjected to discrimination in any program or activity for which it is
responsible, or for which it receives financial assistance from the U.S. Department of Education or the Michigan
Department of Education.

CERTIFICATION REGARDING TITLE II OF THE AMERICANS WITH DISABILITIES ACT (ADA), P.L. 101-
336, STATE AND LOCAL GOVERNMENT SERVICES (for Title II applicants only)

The Americans with Disabilities Act (ADA) provides comprehensive civil rights protections for individuals with
disabilities. Title II of the ADA covers programs, activities, and services of public entities. Title II requires that,
“No qualified individual with a disability shall, by reason of such disability be excluded from participation in or be
denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by
such entity.” In accordance with Title II ADA provisions, the applicant has conducted a review of its employment
and program/service delivery processes and has developed solutions to correcting barriers identified in the review.


CERTIFICATION REGARDING TITLE III OF THE AMERICANS WITH DISABILITIES ACT (ADA), P.L. 101-
336, PUBLIC ACCOMMODATIONS AND COMMERCIAL FACILITIES (for Title III applicants only)

The Americans with Disabilities Act (ADA) provides comprehensive civil rights protections for individuals with
disabilities. Title III of the ADA covers public accommodations (private entities that affect commerce, such as
museums, libraries, private schools, and day care centers) and only addresses existing facilities and readily
achievable barrier removal. In accordance with Title III provisions, the applicant has taken the necessary action to
ensure that individuals with a disability are provided full and equal access to the goods, services, facilities,
privileges, advantages, or accommodations offered by the applicant. In addition, a Title III entity, upon receiving a
grant from the Michigan Department of Education, is required to meet the higher standards (i.e., program
accessibility standards) as set forth in Title III of the ADA for the program or service for which they receive a
grant.

IN ADDITION

This project/program will not supplant nor duplicate an existing early childhood or family development program.
SPECIFIC PROGRAM ASSURANCES

Should the grant be awarded, the following provisions are understood by the grant recipients:

1. The grant award is approved and is not assignable to a third party without specific approval.

2. Funds shall be expended in conformity with the budget. Line item changes and other deviations from the
   budget as attached to this grant agreement must have approval from the Office of Great Start/Early Childhood
   Education and Family Services of MDE.

3. MDE is not liable for any costs incurred by the grantee prior to the issuance of the grant award.

4. Payments, records, and financial statements made under the provision of this grant will be made accessible and
   are subject to audit by the grantor.

5. Each grantee shall comply with all reporting requirements and due dates, including but not limited to, the
   Michigan Student Database System (MSDS).

6. Each eligible grantee acknowledges their program may be selected to participate in national, regional and/or
   state-wide GSRP data collection efforts.

Acceptance of GSRP funds requires that if your program is selected to be a part of a GSRP evaluation project that
it will cooperate fully with the state, its designated evaluation contractor, and any of the state’s other research
partners. That cooperation includes but is not limited to:

● making classrooms available for observation,

● providing non-classroom space on-site for child assessment,


● allowing administrators and staff to take time to complete surveys and questionnaires (by phone, online, on
  paper, or in-person as necessary),

● returning completed surveys and questionnaires promptly and regularly to the contractor or to any of the
  state’s other research partners,

● providing program information to the contractor, any of the state’s other research partners. This information
  may include but is not limited to: program type, session types, session hours, program calendar of school
  breaks, field trips, and staff development, site locations, numbers of classrooms per site, number of children
  served, staffing assignments within classrooms,

● providing children’s unique identification number as recorded in the Michigan Student Data System to the
  contractor or any of the state’s other research partners,

● participating in project informational webinars, conference calls, and in-person meetings


● distributing parent information letters/consent forms, and

● collecting and forwarding to the evaluation contractor, or any of the state’s other research partners, parent
  consent forms promptly and regularly.
                          THE GREAT START READINESS PROGRAM (GSRP)
                            2012-2013 COMPETITIVE GRANT PROPOSAL



                                               Need and Capacity
This report must be a collaborative effort that includes representation from at least the current school
district and public school academy GSRP grantees, competitive grantees, Early Childhood Special
Education, Head Start grantees, and Title I preschools, where applicable. Considering the catchment
area proposed by the agency, complete the table below.


                                                                                                        Number
a. Estimate the number of 4 year-old children for 2012-13:
b. Estimate the number of 4 year-old children eligible for GSRP in school year 2012-13:
c. List Competitive and Formula GSRP grantees (exclude applicant's current enrollment),
   with number of children served this year (2011-12):
      1.
      2.
      3.
      4.
      5.
      6.
      7.
      8.
      9.
    10.
    11.
    12.
    13.
    14.
    15.
    16.
    17.
    18.
    19.
    20.
    21.
    22.
    23.
                                                                                          Subtotal:          0
d. List Head Start grantees, with number of 4 year-old children served this year (2011-12):
   1.
   2.
   3.
                                                                                          Subtotal:          0
e. Estimated number of children in catchment area eligible for GSRP and not being served in GSRP
   or Head Start. (Item b - Subtotal c - Subtotal d)                                                         0
f. Considering the number of children qualified for GSRP (item e), enter the number of children
   this agency is requesting to serve AND is able to provide facilities and staff for Part-Day
   preschool or GSRP/Head Start Blend in the next fiscal year.
g. Based on the 2 for 1 rule in current GSRP legislation, this is the number of children this agency
   indicates are still available to be served in a GSRP School-Day preschool.                              0.0
h. Considering the number of children qualified for GSRP School-Day (item g), enter the number of
   children this agency is requesting to serve AND is able to provide facilities and staff to provide
   School-Day preschool.
                      THE GREAT START READINESS PROGRAM (GSRP)
                        2012-2013 COMPETITIVE GRANT PROPOSAL


                                              Project Fact Sheet
Instructions: Please complete this screen to indicate the programming option(s) that will be provided by the
grantee. Information provided in Items 1a-d will automatically populate lines 25, 26, and 27 of the Cover Page.
Catchment area information provided in Item 2d will automatically populate the Catchment Area section of the
Collaboration screen.
 1. PROGRAM INFORMATION

     a. Maximum award allowed based on Need & Capacity (Item f + h):

     b. Slots requested at $3,400 per slot to implement:
          Part-Day Preschool
          GSRP/Head Start Blend Preschool

     c.   Slots requested at $6,800 per slot to implement:
          School-Day Preschool

     d. Total amount requested:                                                        $0

 2. DELIVERY OF SERVICES

     a. Beginning date of program (mm/dd/yyyy):

     b. Ending date of program (mm/dd/yyyy):

     c.   Number of weeks of program:                                         0
           FALSE   FALSE      FALSE     FALSE     FALSE
     d.   Catchment area:
          Note: Identify the areas of established need.

          Counties:



          Cities, Towns, Villages
          (Complete only if Counties cannot adequately describe the Catchment Area):




          Optional - If zip code would further define area of need, list zip codes:
                  THE GREAT START READINESS PROGRAM (GSRP)
                    2012-2013 COMPETITIVE GRANT PROPOSAL


                             Great Start Collaborative Endorsement
Instructions: See proposal instructions for the complete process to obtain and submit the endorsement of the
local Great Start Collaborative.
                        Collaborative Name                                       Area Code & Phone Number


  GREAT START
 COLLABORATIVE          Address                             City                 Zip Code




                        Sir Title      First Name           Last Name            Area Code & Phone Number
  GREAT START
COLLABORATIVE
DIRECTOR/CHAIR          Email Address of Director/Chair                                      Date


        Catchment area will populate automatically when Project Fact Sheet is completed.

                        Counties:




    CATCHMENT           Cities:
       AREA



                        Zip Codes:




Note: If not funded in previous year, enter zeros below.
2011-12 GSRP Information                 Part-Day Slots @ $3,400         School-Day Slots @ $6,800
Slots requested
Slots awarded
Slots accepted
Slots filled to date

The local GSC is involved in collaborative efforts with GSRP and its community partners to plan
for effective use of funding to meet the needs of the local community (e.g., program options,
transportation, etc.). The GSC endorses a GSRP grantee that partners with the GSC in strategic
efforts to provide high-quality preschool, fostering school readiness and life success for families
residing within the GSC region.

The GSC has received the above applicant’s assessment of community need and its capacity to
provide GSRP services and responds as follows:

     REVIEWED - The GSC has reviewed the proposal. This designation acknowledges GSC
     awareness of the proposal, but does not comment on the proposal’s suitability, and may be
     used when the prospective GSRP grantee provides insufficient time for review of the
#### proposal.

     NOTICE OF SUPPORT - The GSC has reviewed the proposal and is in support of its
     funding by the Michigan Department of Education, but only the most basic levels of
#### collaboration is established (e.g., networking, coordinating and/or cooperating).

     ENDORSED - The GSC assures the proposal builds the additional program/service capacity
#### needed in the community and is part of an integrated delivery system.

Signature of Great Start
                                                                                      Date
Collaborative Director/Chair
                    THE GREAT START READINESS PROGRAM (GSRP)
                      2012-2013 COMPETITIVE GRANT PROPOSAL



                                           Subcontract Agencies
              Name of Subcontract Agency (if any)               Federal ID Number          Area Code & Phone Number


SUBCONTRACT
  AGENCY      Address                               City        Zip Code                   County



              Sir Title     First Name              Last Name   Area Code & Phone Number   Fax Number


  CONTACT
  PERSON      Email Address of Contact Person




              Name of Subcontract Agency (if any)               Federal ID Number          Area Code & Phone Number


SUBCONTRACT
  AGENCY      Address                               City        Zip Code                   County



              Sir Title     First Name              Last Name   Area Code & Phone Number   Fax Number


  CONTACT
  PERSON      Email Address of Contact Person




              Name of Subcontract Agency (if any)               Federal ID Number          Area Code & Phone Number


SUBCONTRACT
  AGENCY      Address                               City        Zip Code                   County



              Sir Title     First Name              Last Name   Area Code & Phone Number   Fax Number


  CONTACT
  PERSON      Email Address of Contact Person




              Name of Subcontract Agency (if any)               Federal ID Number          Area Code & Phone Number


SUBCONTRACT
  AGENCY      Address                               City        Zip Code                   County



              Sir Title     First Name              Last Name   Area Code & Phone Number   Fax Number


  CONTACT
  PERSON      Email Address of Contact Person
              Name of Subcontract Agency (if any)               Federal ID Number          Area Code & Phone Number


SUBCONTRACT
  AGENCY      Address                               City        Zip Code                   County



              Sir Title     First Name              Last Name   Area Code & Phone Number   Fax Number


  CONTACT
  PERSON      Email Address of Contact Person




              Name of Subcontract Agency (if any)               Federal ID Number          Area Code & Phone Number


SUBCONTRACT
  AGENCY      Address                               City        Zip Code                   County



              Sir Title     First Name              Last Name   Area Code & Phone Number   Fax Number


  CONTACT
  PERSON      Email Address of Contact Person




              Name of Subcontract Agency (if any)               Federal ID Number          Area Code & Phone Number


SUBCONTRACT
  AGENCY      Address                               City        Zip Code                   County



              Sir Title     First Name              Last Name   Area Code & Phone Number   Fax Number


  CONTACT
  PERSON      Email Address of Contact Person




              Name of Subcontract Agency (if any)               Federal ID Number          Area Code & Phone Number


SUBCONTRACT
  AGENCY      Address                               City        Zip Code                   County



              Sir Title     First Name              Last Name   Area Code & Phone Number   Fax Number


  CONTACT
  PERSON      Email Address of Contact Person
                      THE GREAT START READINESS PROGRAM (GSRP)
                        2012-2013 COMPETITIVE GRANT PROPOSAL


                                                    Site License Status
          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed          site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained        application submitted          fire inspection completed
             health inspection completed           site visit made by consultant, corrections needed
                      THE GREAT START READINESS PROGRAM (GSRP)
                        2012-2013 COMPETITIVE GRANT PROPOSAL


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed
                      THE GREAT START READINESS PROGRAM (GSRP)
                        2012-2013 COMPETITIVE GRANT PROPOSAL


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed
                      THE GREAT START READINESS PROGRAM (GSRP)
                        2012-2013 COMPETITIVE GRANT PROPOSAL


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed
                      THE GREAT START READINESS PROGRAM (GSRP)
                        2012-2013 COMPETITIVE GRANT PROPOSAL


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed
                      THE GREAT START READINESS PROGRAM (GSRP)
                        2012-2013 COMPETITIVE GRANT PROPOSAL


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed


          Site Name                                                Address                              City



          License/Approval Number                                  Effective Date                       Expiration Date
LICENSE
STATUS
          If site is not currently licensed, please check all that apply.                                      License extended

             application obtained          application submitted         fire inspection completed

             health inspection completed            site visit made by consultant, corrections needed
             THE GREAT START READINESS PROGRAM (GSRP)
               2012-2013 COMPETITIVE GRANT PROPOSAL


                                       Narrative
Instructions: This section consists of multiple questions. Each question should be
answered in the space provided. Use the included rubrics, the Early Childhood
Standards of Quality for Prekindergarten , the Great Start Readiness Program
Implementation Manual , and other resources to determine what should be included in
each answer.
Please limit responses to 1,024 characters. Use of Arial 10 pt. font will ensure
visibility of text in the space provided.

1)   Describe the process used to locate and recruit eligible children:




2)   Describe how children’s eligibility will be determined:




3)   Describe the system that will be implemented to ensure that there is
     documentation of each child’s eligibility status and prioritization for enrollment:
4)   Describe the program’s philosophy of early childhood education:




5)   Report a comprehensive, standardized developmental screening tool:


                                                                            1
     If "other" or "none," please explain:




6)   Report a research based, comprehensive curriculum or model/approach:


                                                                            1
     If "other" or "none," please explain:
7)   Report a comprehensive ongoing child assessment tool:


                                                                                     1
     If "other" or "none," please explain:




Answer either questions 8 and 9 or questions 10 and 11, as appropriate for
your program. If the applicant intends to have both Classroom-Based and
Home-Based options, please see the instructions for more guidance.


8)   For Classroom-Based (Center-Based) programs, provide a sample Daily Routine
     that includes all required parts of the day:

              Please complete the "Center-Based Daily Routine" worksheet which
                      is available on the next tab of this Excel workbook.

9)   For Classroom-Based (Center-Based) programs, describe policies and procedures
     for home visits and formal parent conferences:
10)   For Home-Based programs, describe home visits:




11)   For Home-Based programs, describe cluster activities:




12)   How will parents be engaged in the program activities?
13)   How will parents’ participation on the Advisory Committee be ensured?




14)   Describe the role and responsibilities of the Early Childhood Specialist (ECS) in
      your program. NOTE: The ECS cannot also be a lead teacher in this GSRP
      program.




15)   How will the effectiveness of the teaching team be evaluated as it relates to the
      program?
16)   Describe how the data from the PQA [or other tool(s) for Home-Based programs],
      the child assessment tool, and other data sources will be collected and used to
      make decisions about the program.




17)   How will staff receive training in a selected screening tool, curriculum, child
      assessment tool, program requirements, PQA, and the Early Childhood Standards
      of Quality for Prekindergarten ?
                            THE GREAT START READINESS PROGRAM (GSRP)
                              2012-2013 COMPETITIVE GRANT PROPOSAL


                                                   Daily Routine
8. For Classroom-Based (Center-Based) programs, provide a sample Daily Routine that includes all required
   parts of the day:
Instructions for Center-Based Programs Only: Complete the chart to reflect a consistent classroom schedule which
includes all required GSRP elements.


   Time Frame        Part of the Day      Description: Include what adults and children do for each part of the routine.
                                         THE GREAT START READINESS PROGRAM (GSRP)
                                           2012-2013 COMPETITIVE GRANT PROPOSAL



                                                                     Budget Detail
  Grant           Grant                  Grant              Fiscal
 Number       Starting Date           Ending Date            Year
 135170          10/1/12                9/30/13              2013
                                                                                Instructions
● Adjust individual row height so that all text in the Description field is visible.
● Rows cannot be added or deleted, but can have their Row Height reduced by clicking just under the Row # and dragging upwords. Selecting multiple
  rows at one time and dragging upword is possible.
● Use Copy & Paste for Columns A-K to move data down to accommodate an insertion. The Total column cannot be selected.
● The Budget Detail Total must equal the total requested.
                                                                                                    Supplies
                                                                                     Purchased         &           Capital       Other
Function                                        FTE /      Salaries      Benefits     Services      Materials      Outlay      Expenses
 Code                  Description              Hours       1000          2000       3000, 4000       5000          6000       7000, 8000       Total
Budget Detail Totals:             $0   $0   $0   $0   $0   $0   $0

Amount Requested on Cover Page:                                 $0
                                                                      ContactHonorific
Agency FedID AgencyPhone AgencyStreet AgencyCity AgencyZip AgencyCounty
      0     0           0            0          0         0         0                 0
ContactFirst ContactLast ContactPhone ContactFax ContactEmail 2ndContactHonorific 2ndContactFirst
           0           0             0          0           0                    0               0
2ndContactLast 2ndContactPhone 2ndContactFax 2ndContactEmail PartDayRequest FullDayRequest
              0               0             0               0            $0              $0
TotalRequest        OCDP3orMoreYrs ProjReimagine ProvSCC AuthOfficial AuthOffPhone Date
               $0                0              0      0            0            0 ######
Nca-Est4yrOlds NCb-Est4yrGsrpElig NCc-TotGsrpServed       NCd-TotHSServed
             0                   0                    0                     0
Nce-EstNumNotServed NCf-PartDayRequest       NCg-AvailSchoolDaySlots       NCh-SchoolDayRequest
                  0                      0                             0                          0
PartDay AllDayAltDay HSBlend Migrant FullDay Home AmtReq BegDate EndDate NumWeeks
      0     #REF!           0 #REF!        0 #REF!     0       0       0        0
CountyNeed CityNeed ZipNeed CollabName CollabPhone CollabChairFname CollabChairLname
         0         0      0          0           0                 0                0
CollabChairEmail CollabReviewed   CollabSupport   CollabEndorsed   Subcontract1
               0      FALSE            FALSE           FALSE                      0
Subcontract2       Subcontract3       Subcontract4       Subcontract5       Subcontract6
               0                  0                  0                  0                  0
Subcontract7       Subcontract8       Nar5-DevScrTool       Nar6-CurrModel       Nar7-ChildAssessTool
               0                  0                     1                    1                     1
                                  THE GREAT START READINESS PROGRAM (GSRP)
                                    2012-2013 COMPETITIVE GRANT PROPOSAL

        Proposal Item                        Response                        Notes
Agency                    0
FedID                     0
AgencyPhone               0
AgencyStreet              0
AgencyCity                0
AgencyZip                 0
AgencyCounty              0
ContactHonorific          0
ContactFirst              0
ContactLast               0
ContactPhone              0
ContactFax                0
ContactEmail              0
2ndContactHonorific       0
2ndContactFirst           0
2ndContactLast            0
2ndContactPhone           0
2ndContactFax             0
2ndContactEmail           0
PartDayRequest            $0
FullDayRequest            $0
TotalRequest              $0
OCDP3orMoreYrs            0
ProjReimagine             0
ProvSCC                   0
AuthOfficial              0
AuthOffPhone              0
Date                      0
Nca-Est4yrOlds            0
NCb-Est4yrGsrpElig        0
NCc-TotGsrpServed         0
NCd-TotHSServed           0
Nce-EstNumNotServed       0
NCf-PartDayRequest        0
NCg-AvailSchoolDaySlots   0
NCh-SchoolDayRequest      0
PartDay                   0
AllDayAltDay              #REF!
HSBlend                   0
Migrant                   #REF!
FullDay                   0
Home                      #REF!
AmtReq                    0
BegDate                   0
EndDate                   0
NumWeeks                  0
CountyNeed                0
CityNeed                  0
ZipNeed                   0
CollabName                0
CollabPhone               0
CollabChairFname          0
CollabChairLname          0
CollabChairEmail          0
CollabReviewed            FALSE
CollabSupport             FALSE
CollabEndorsed            FALSE
Subcontract1              0
Subcontract2              0
Subcontract3              0
Subcontract4              0
Subcontract5              0
Subcontract6              0
Subcontract7              0
Subcontract8              0
Nar5-DevScrTool           1
Nar6-CurrModel            1
Nar7-ChildAssessTool      1

				
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