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Kohl Breakfast Enhancement Grant Application Instructions by Imwithjanet


									                            Kohl School Breakfast Enhancement Grant
                             Form PI-6053B Application Instructions
                                               I. GENERAL INFORMATION

Box # 1:    Name of your school food authority as it appears on your National School Lunch Program contract

Box # 2:    Completed

Box # 3:    Mailing Address

Box # 4:    Agency Code - the six digit agency code as it appears on your contract

Box # 5:    CESA Number - if unsure please refer to:

Box # 6:    Official Contact - is the person to be contacted to answer any questions concerning the application

Box # 7:    Title of the Official Contact person (box # 6)

Box # 8:    Email Address of the Official Contact person (box # 6)

Box # 9:    Phone number of the Official Contact person (box # 6)

Box # 10:   Fax number of the Official Contact person (box# 6)

Box # 11:   Program Coordinator - list the person in charge of the school breakfast program, if different from the Official Contact
            person, listed in box # 6

Box # 12:   Title of the Program Coordinator

Box # 13:   Email address of the Program Coordinator

Box # 14:   Phone number of the Program Coordinator

Box # 15:   Fax number of the Program Coordinator

Box #16:    Program Coordinator mailing address

Box # 17:   Summer Contact - list the person to be contacted if there are any questions on the application that need to be
            answered during the approval process this summer

Box # 18:   Summer Contact person summer phone number

Box # 19:   Proposed Breakfast serving model - check all that apply

Box # 20:   Food Preparation Method - check all that apply

Box # 21:   Describe School Location - check one box

Box # 22:   Total Funds Requested - list the amount of money that the school/SFA is requesting for the breakfast grant

Box # 23:   Free/Reduced Price Meal Data from October 2008 Claim - provide the numbers for each box based off of the
            school/SFA October2008 claim for reimbursement submitted to DPI for payment

                                                      II. AGREEMENT SECTION

This section represents the legal agreement and requirements if funds are awarded. Please read carefully before signing.


This agreement is legally binding and as such must be signed by the School Board President or Clerk for public schools or the
Administrator for private schools.

                                                    III. ELIGIBLE SCHOOLS
                                         (For which an improvement grant is requested)

For each school building requesting a participation improvement breakfast grant, complete the following information by line:

        School Building Name for which a participation improvement grant is requested - list the name of school, address and
         contact person’s name and email address

        Building Enrollment - total enrollment in this building as of April 1, 2009 or May 1, 2009

        Building Grade Levels Served - list what grade levels are in the school

        No. of Children Approved for: Free Meals/Reduced Priced Meals - list the data as of April 1, 2009 or May 1, 2009

        Planned Implementation Date - date that the school breakfast program began or will begin in this building

        Projected Average Daily Participation: For Breakfast/For Lunch - List the lunch participation of this building as of April or
         May 2009 and then estimate the breakfast participation. This estimate will be used to prorate any equipment needed and
         used over both meals. In addition, these projections will be used to assist with the overall review of your proposal.

        Your proposal will receive careful evaluation. If demand for funds exceeds the total amount available, prorating will
         occur to serve as many buildings as possible. Every effort will be made to fund one building in each SFA submitting an
         approved grant proposal. If you choose to identify more than one school building for funding, please prioritize by number in
         the margin to assist us in serving your needs better.


                                                       IVa. BUDGET SUMMARY

Your request for participation improvement funds through this grant must be presented in the designated budget categories. The
feasibility of your proposal is judged on the information offered on the line item budget and the fifth page detailed explanations of those
expenses. Please note this grant does not fund food costs except in the case of outreach when up to one week of free
breakfast is offered to students. In addition, parents may be offered one free breakfast to promote the program and increase
outreach. More details are available in these instructions under the line budget item – outreach/publicizing.

Budget line “a” - Labor
Any additional labor incurred to redesign the school breakfast program for participation improvement is fundable. Total funds for labor
not to exceed 50% of total amount requested. Please enter the total amount needed for labor on line “a” in the Budget Summary and
provide a detailed breakdown of positions, hours utilized for school breakfast, fringe benefits claimed with percentage used, hourly rate
and days of breakfast in the line item explanation on page five (IVb. LINE ITEM BUDGET EXPLANATION).

Budget line “b” - Equipment
Equipment needed to prepare and serve breakfast to students is included on line “b.” Equipment that will be used for both breakfast
and lunch service will be prorated. For example, assume an oven (cost of $5000) would be purchased for use in both lunch (ADP 100)
and breakfast (ADP 20) programs. We would anticipate 1/5 or $1,000 of the oven cost would be requested in this grant. This $1,000
expenditure would appear in the Budget Summary on line” b” for equipment and be supported by a line item explanation on page five.
The explanation must include the total cost of the oven and how you calculated the amount listed in the budget. However, equipment
such as a conveyor toaster would be fully fundable if exclusively used at breakfast.

Budget line “c” - Outreach/Publicizing
This area can be utilized to provide funding for activities to promote and enhance your program. You may provide up to one week free
breakfast for all students. You may also provide one free breakfast to parents participating with students to enhance outreach. This
is the only time food costs are allowable under this grant. Paper, supplies and advertising costs used to publicize your program
may be detailed as outreach. These costs would appear in the Budget Summary on line “c” for outreach/publicizing supplies and be
supported by a line item explanation on page five.

Budget line “d” - Training
This will reflect any costs associated with training food service or instructional staff on the breakfast program. The total would appear in
the Budget Summary on line “d” for training and be supported by a line item budget explanation on page five.

Budget line “e” - Travel
Travel associated with the school breakfast program may be applied to this category. This may include travel for school breakfast
training (i.e. school breakfast conference). Travel must be carefully detailed with projected miles and purpose of travel with its
relationship to the school breakfast program. Again the total would appear in the Budget Summary on line “e” for travel and be
supported by a line item explanation on page five.

Budget lines “f”- Other
Line “f” is marked “Other” to accommodate a line item you may wish to add for funding. These items must be well supported in the Line
ITEM BUDGET EXPLANATION on page five. Disposable and paper costs are often shown here. These costs can be substantial for
programs opting for a fully disposable service at breakfast to decrease labor and cleanup.

Once all budget lines are complete, please add for the total. If filling out the application electronically, the sum of these budget lines will
already be totaled for you. This is the total request for your school breakfast program. While there are no minimum or maximum
amounts established, each grant application is reviewed carefully to insure the requested funding is reasonable and supportive of a
viable program to serve your students.

                                              IVb. LINE ITEM BUDGET EXPLANATION

Each line item in the Budget Summary on page four must have a corresponding description validating the expense for improving the
program. This allows you to explain your rationale for items while supporting the total line budget item. Each budget line will have a
narrative explanation to be considered a complete grant application presented on page five of the application. Budgeted expenditures
for which an explanation is not provided may not be approved.

                                                 V. ASSESSMENT/OBJECTIVE/PLAN

In this section, provide answers to the questions asked related to assessing the need for improving your school breakfast program,
defining objectives for your program and how you plan to implement the changes. Objectives should be well defined and measurable.
Attach an additional page as needed.

                                            VI. EVALUATION/FOLLOW-UP/SHARING

You are required to submit to DPI:
    1. Mid-year Evaluation due in January evaluating the following (1) objectives met to date (2) major challenges or delays
         encountered and how they be resolved (3) success achieved
    2. End of the year Report assessing the following (1) success (2) struggles/challenges (3) ease of implementation, etc.

Follow-up evaluations will be sent in a separate mailing.

Grant application questions should be directed to Sarah Combs by phone (608-266-7112) or email ( or Kelly
Williams by phone (608-267-9276) or email (


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