FORM ED-241A CONNECTICUT STATE DEPARTMENT OF by rdp21471

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									                           STATE OF CONNECTICUT
                                   DEPARTMENT OF EDUCATION




TO:           Superintendents of Schools and Authorized Agency Heads

FROM:         Charlene Russell-Tucker, Associate Commissioner
              Division of Family and Student Support Services

DATE:         June 10, 2009

SUBJECT:      FY 2008-09 Adult Education Summary Reports

The Connecticut State Department of Education (CSDE) collects year-end information, program
data and financial expenditures pertaining to Adult Education using separate forms and formats.
The ED-241 Summary Report for Adult Education and the ED-241A Summary Report for Adult
Education Cooperating Eligible Entity are submitted to the Bureau of Health/Nutrition, Family
Services and Adult Education. The ED-141 Statement of Expenditure Report is submitted
electronically to the Division of Finance and Internal Operations. All forms require information
pertaining to mandated adult education activities and expenditures supported under Connecticut
General Statutes Section 10-67 through 10-73 and are due on or before September 1, 2009.

Requirements for completion of the ED-241, ED 241A and ED-141

ED-241     Providers of adult education mandated programs must complete the ED-241 Summary
           Report for Adult Education for submission to the Bureau of Health/Nutrition, Family
           Services and Adult Education. This form collects information and data regarding
           program offerings, services, activities, enrollment and student assessment for the
           mandated program. Cooperator districts are not required to complete a separate ED-241.
           This form is completed by the provider district and is approved by the cooperating
           district(s).

ED-241A Cooperating Eligible Entity (CEE) grant recipients must complete the ED-241A
        Summary Report for Adult Education Cooperating Eligible Entity for submission to the
        Bureau of Health/Nutrition, Family Services and Adult Education. This form also
        collects information and data regarding services, activities, enrollment and student
        assessment. The authorized CEE agency head completes the ED-241A with the approval
        of the providing district.

ED-141     Every school district that received adult education funds from the CSDE as a provider or
           as a cooperator must complete and submit the ED-141 Statement of Expenditure Report
           to the Division of Finance and Internal Operations. This form collects information on
           grant expenditures. Additionally, provider districts that received CEE grants must submit
           an ED-141 for each CEE grant. Information regarding the ED-141 will be sent directly
           to the district’s business manager by the Division of Finance and Internal Operations.
           Please contact Annette McCall at 860-713-6466 if you have questions regarding the
           ED-141.

                  25 Industrial Park Road  Middletown, Connecticut 06457
                                 An Equal Opportunity Employer
FY 2008-09 Adult Education Summary Reports
June 10, 2009
Page 2


The ED-241 Summary Report for Adult Education and the ED 241A Summary Report for Adult Education
Cooperating Eligible Entity forms for FY 2008-09 can be accessed from the State Department of Education’s
website at www.sde.ct.gov. Click on “Adult Education” located to the left of the page. Once on the Adult
Education web page, click on “Legislation and Funding” then click on State Grants. The cover page of each
form provides detailed directions for completing and submitting the summary reports.

Two signed copies of the ED 241/241A, one with original signatures, must be received in the Bureau of
Health/Nutrition, Family Services and Adult Education on or before September 1, 2009. If there are
questions regarding the completion of the ED-241, please contact Valerie R. Marino, Program Manager, at
valerie.marino@ct.gov or 860- 807-2130.


CRT:vmm
cc:  Mark K. McQuillan, Commissioner
     Paul F. Flinter, Bureau Chief
     Valerie R. Marino, Program Manager
     Adult Education Directors
                                                   ED241A
                  CONNECTICUT STATE DEPARTMENT OF EDUCATION

                        SUMMARY REPORT FOR ADULT EDUCATION
                            COOPERATING ELIGIBLE ENTITY

                                                  2008-2009

                                INSTRUCTIONS FOR COMPLETION



GENERAL INFORMATION
In accordance with Section 10-71(b) of the 2008 Supplement to the Connecticut General Statutes (C.G.S.),
Cooperating Eligible Entities (CEEs) that are recipients of state grants for adult education must submit to the
Connecticut State Department of Education (CSDE) a Summary Report. CEE s will use form ED-241A to
report program services, activities and outcomes including information and data pertaining to enrollment,
student performance, program quality, professional development and collaborations.


SUBMISSION OF ED-241A
Complete the Summary Report form according to the instructions. Send two (2) typed copies (one with
original signatures) and a copy of your agency’s final Program Profile for FY 2009 to:

                                    Valerie R. Marino, Program Manager
                                 Connecticut State Department of Education
                       Bureau of Health/Nutrition, Family Services and Adult Education
                                           25 Industrial Park Road
                                       Middletown, Connecticut 06457

The ED-241A must be received in the Bureau of Health/Nutrition, Family Services and Adult Education on or
before September 1, 2009. Be sure to retain a copy for your files. A copy of the ED-241A Summary Report
Cooperating Eligible Entity should be sent to the adult education director for the district.

For further information or assistance, please contact Valerie R. Marino, Program Manager at
valerie.marino@ct.gov or 860-807-2130.
FORM ED-241A                                          CEE Agency/District:________________/_______________
Rev. 6/09                                                                          Year 2008-2009
CGS 10-67 through 10-73c

                          CONNECTICUT STATE DEPARTMENT OF EDUCATION
                                              SUMMARY REPORT
                                         COOPERATING ELIGIBLE ENTITY

                                                 INSTRUCTIONS

1. Form ED-241A must be received in the Bureau on or before September 1, 2009.
2. Submit two stapled typewritten copies (one with original signatures) to the address below.
3. Be sure to include your agency’s final Program Profile for FY 2009 with the ED-241A submission.
4. Send CEE Summary Report to:
                                Valerie R. Marino, Program Manager
                                Connecticut State Department of Education
                                Bureau of Health/Nutrition, Family Services and Adult Education
                                25 Industrial Park Road
                                Middletown, Connecticut 06457

PROVIDER INFORMATION

 1. Applicant Organization: (District)                                   Town/Agency Code:

 2. Name of Cooperating Eligible Entity:                                 Telephone:

 3. Street Address:                                                      City:                       Zip:
 4. Completed by:                                                        Telephone
 5. Signature:                                                           Title:


A. TOTAL ADULTS SERVED:
   To complete columns B, C and D of the chart below, refer to the Program Enrollment and Student Demographics
   section of your program’s final Program Profile for FY 2009.

                            A. PROGRAM ENROLLMENT/STUDENT DEMOGRAPHICS
                         A                     B                   C                     D
                      Program             FY 08 Student Ethnicity: list the   Age: list the age
                       Areas                 Count      ethnicity with the    cohort with the highest
                                                        highest student count student count
     Citizenship
     English as a Second Language (ESL)

                                  *TOTAL


     Adult Basic Education
     (ABE)/General Educational
     Development (GED Preparation

                                  *TOTAL



                                                         1
ED-241A Continued               CEE Agency/District:__________________/___________________               Year 2008-2009

B. CEE BUDGET SUMMARY:
     To complete the chart below, refer to the agency’s final grant award notification and the CEE’s final private source
     commitment for FY 2009. Private source funds should not be less that amount reported on the ED-245A.

                                             B. CEE BUDGET SUMMARY
     FY 2008-09 State Grant Dollars              FY 2008-09 Private Source Funds              FY 2008-09 Total Expenditure
 $                                           $                                           $

 The agency maintains a separate
 bank account for the CEE funds              YES                                         NO
  (check () appropriate column)

C. PERSONNEL INFORMATION:
     Record the number of staff members associated with the state adult education CEE grant in the appropriate column.

                                 C. CEE PROGRAM PERSONNEL INFORMATION
                                                                               NUMBER
           Program Personnel                  Part-time (paid)        Full-time (paid)              Volunteer Positions
                Director
                Supervisors
                 Teachers
                   Aides
               Clerical Staff
                   Other
                  Tutors


D. PROFESSIONAL DEVELOPMENT:
     Complete the chart below as it pertains to the staff of the adult education CEE grant.

                                       D. PROFESSIONAL DEVELOPMENT
1. Number of CEE staff only.

2. Number of CEE staff who attended adult education professional development offered
   through the Adult Training and Development Network (ATDN).
3. Number of CEE staff who attended adult education professional development offered through
   other sources.
4. Total dollar amount of CEE adult education dollars expended on professional development for
                                                                                                           $
   the CEE staff.
5. List professional development outcomes your program achieved.




                                                              2
    ED-241A Continued             CEE Agency/District:__________________/___________________           Year 2008-2009

    E: PROGRAM COLLABORATION
          To complete this section, refer to Section One of the Program Quality Plan of your agency’s ED-244A for FY 2009
          Respond thoroughly to each question.

1. Describe the services provided by each of the collaborating agencies.




2. Describe how the services offered through the CEE grant have enhanced/supplemented (not supplanted)
   services to the target population.




3. How was the effectiveness of the collaboration evaluated?




F. PROGRAM QUALITY
         To complete this section, refer to the Program Quality section of your agency’s ED-244A and the final Program
         Profile for FY 2009.

        List the goals, objectives and activities that were established in the ED-244A,
        Evaluate the success of each activity based on the anticipated outcome and evaluation criteria stated in your
         ED-244A. Please provide objective measurement and details that demonstrate success. Provide an explanation if
         the activity was unsuccessful.


    Goal 1:
    Objectives:

    Activities (list in numerical order)                             Evaluation of Success Based on Measurable Outcomes
    1.


    2.


    3.




                                                                 3
 ED-241A Continued           CEE Agency/District:__________________/___________________     Year 2008-2009

F. PROGRAM QUALITY continued:


 Goal 2:

 Objectives:


 Activities (list in numerical order)                      Evaluation of Success Based on Measurable Outcomes
 1.



 2.



 3.




 Goal 3:

 Objectives


 Activities (list in numerical order)                      Evaluation of Success Based on Measurable Outcomes
 1.




 2.




 3.




                                                       4
ED-241A Continued              CEE Agency/District:__________________/___________________                     Year 2008-2009

G. STUDENT RETENTION SUMMARY:
   To complete columns B, C and D of the chart below, refer to the Supplemental Information of your final
   Program Profile for FY 2009 and record the data shown. To complete column E, subtract column C from column D.

                                 G. STUDENT RETENTION BY PROGRAM AREA
        A                       B                          C                         D                          E
                       Percentage (%)             Number (#) of             Number (#) of          Number (#) of Students
                       of Students with 12        Students with 12+         Students with 1+       who discontinued prior to
  Program Area
                       + hours of                 hours of                  hours of               attending 12 + hours
                       attendance                 attendance                attendance
ABE/GED
ESL/Citizenship

H. STUDENT PRE -TEST DATA:
   To complete column C of the chart below, refer to the Supplemental Information section your final
   Program Profile for FY 2009. Provide a brief statement that explains the reasons for your program’s percentages.

                                             H. STUDENT PRE-TEST DATA
       A                                          B                                                       C
  Program Area        Connecticut’s Goal for Students 12 + hrs. with a Pre-test   Program’s % of Students 12 + hrs. with a Pre-test

ABE/GED                                         90%
ESL/Citizenship                                 90%

Statement:




I. STUDENT PERFORMANCE:
  To complete columns B, C and D of the chart below, refer to Student Performance by Program Area section of your
  final Program Profile for FY 2009.

                 I. STUDENT PERFORMANCE/ASSESSMENT BY PROGRAM AREA
                  A                                   B                                 C                       D
                                                EDUCATIONAL                          PROGRAM               PERCENTAGE
            MEASURES
                                              FUNCTIONING LEVEL                        AREA                 ATTAINED

Highest Matched Pair Percentage

Lowest Matched Pair Percentage

Highest Percent Making Gain
Lowest Percent Making Gain


Highest Percent Completing a
Level

Lowest Percent Completing a
Level

                                                                  5
ED-241A Continued           CEE Agency/District:__________________/___________________            Year 2008-2009

EDIT CHECK:             This section should be completed by someone other than the individual designated on page 1
                        lines four and five.

Place a check mark () on the line by each item reviewed.


1.        Page 1        Provider Information lines 1-4 accurately completed                    ________

2.        Page 1        Provider Information line 5 has authorized signature                   ________

3.        Page 1        Table A thoroughly and accurately completed                            ________

4.        Page 2        Tables B, C and D thoroughly and accurately completed                  ________

5.        Page 3        Section E questions (3) thoroughly and accurately completed            ________

6.        Pages 3 & 4   Section F, Program Quality Goals thoroughly completed                  ________

7.        Page 5        Tables, G, H and I thoroughly and accurately completed                 ________

8.        N/A           A copy of the agency’s final Program Profile attached                  ________

9.        Page 6        Edit check completed by:




     Signature                                                 Date:



     Print Name:                                               Title:




ED-241A/FY09



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