Application Package for the

Eighth West Virginia Competition

of 21st Century Community Learning Center (21stCCLC) Program

with July 1, 2011 funding

provided by

The West Virginia Department of Education http://21stcclc.k12.wv.us/

with funding from The U.S. Department of Education

http://www.ed.gov/21stcclc http://www.afterschool.gov/cgi-binh/home.pl

Minimum Funding of $50,000

Maximum Funding of $215,000

APPLICATION DUE DATE

The original application, four copies and an electronic copy must be received by 3 p.m., Friday, April 29, 2011, at the office of

Dr. Marsha Bailes, Assistant Director West Virginia Department of Education

Building 6, Room 617 1900 Kanawha Blvd., East

Charleston, WV 25305 Email: mcbailes@access.k12.wv.us

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TABLE OF CONTENTS

FOREWORD ............................................................................................................ 2

TABLE OF CONTENTS ........................................................................................ 3

2011 OVERVIEW .................................................................................................... 4

GENERAL APPLICATION GUIDELINES ........................................................ 6

HOW TO PREPARE AN APPLICATION FOR A 21

STCCLC GRANT .......... 7

APPLICATION NARRATIVE GUIDELINES .................................................... 9

21ST CCLC PROGRAM GOAL, OBJECTIVES AND INDICATORS……..16

COVER PAGES .....................................................................................................17

APPLICATION CHECKLIST FORM ...............................................................19

WV 21

ST CCLC PROJECT SUMMARY AND ABSTRACT FORM ..............20

WVDE – 21

st CCLC GRANT BUDGET FORM ................................................22

EXAMPLE BUDGET NARRATIVE ITEMS ....................................................23

ASSURANCE FORMS ..........................................................................................25

NON-CONSTRUCTION FORM SF 424B ..........................................................29

GEPA Equitable Access form 1890-0007……………………………………....32

2011-2016 WV 21

stCCLC APPLICATION RATING FORM ...........................34

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2010 OVERVIEW

West Virginia Department of Education’s

21st Century Community Learning Center Grant Program

WHAT IS IT? The West Virginia Department of Education (WVDE) is pleased to announce the eighth state 21

st Century Community Learning Center (21

stCCLC)

competition for grants to establish and/or expand community learning centers that will provide extended learning opportunities for school-age children and their families. This program is authorized under Title IV, Part B of the federal Elementary and Secondary Education Act, H.R.-1. Allocations for each state are based upon the state‟s student enrollment and Title I participation. West Virginia expects to award approximately $864,000 in new 21st CCLC grants. WHO CAN APPLY? Public and private organizations may apply for funding. Examples of public and private organizations include, but are not limited to: non-profit agencies, city and county government agencies, faith-based organizations, institutions of higher education, and for-profit agencies. HOW DO WE APPLY? Use the WV 21st CCLC Application Package information to prepare a grant application. The Application Package will be available for download from the WVDE 21st CCLC web site http://21stcclc.k12.wv.us/. A local 21st CCLC grant application must describe: the before-school (optional), after-school and/or summer-school (optional) activities to be funded; how the activities will improve student achievement; how students will travel safely to and from the learning center(s); the partnership(s) between the local county school board and community-based public or private organizations (as appropriate); an assessment of the community needs; available resources for the learning center(s); and other provisions requested in the application package. FOR WHAT ACTIVITIES MAY A GRANTEE USE 21

ST CCLC FUNDS?

Each eligible organization that receives an award may use the funds to carry out a broad array of before- and after-school activities (including during summer recess periods) that advance student achievement. In the view of the U.S. Department of Education and WVDE, local grantees are limited to providing activities within the following list:

remedial education activities and academic enrichment learning programs, including providing additional assistance to students to allow the students

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to improve their academic achievement; mathematics and science education activities, arts and music education activities, entrepreneurial education programs, tutoring services and mentoring programs, programs that provide after-school activities for limited English proficient

students that emphasize language skills and academic achievement, recreational activities, telecommunications and technology education programs, expanded library service hours, programs that promote parental involvement and family literacy, programs that provide assistance to students who have been truant,

suspended, or expelled to allow the students to improve their academic achievement, and

drug and violence prevention programs, counseling programs, and character education programs.

Applicants are reminded of their obligation under section 504 of the Rehabilitation Act to ensure that their proposed community learning centers program activities are accessible to persons with disabilities. HOW MANY GRANTS WILL BE AWARDED AND FOR HOW MUCH? By federal statute, a 21st CCLC grant may not be less than $50,000 per year. Each eligible program may receive up to $215,000. New applicants cannot exceed 5 years with descending funds in years 4 and 5 for successful programs. No matching funds are required. COMPETITIVE PRIORITIES Federal criteria require that states make awards only to applicants that will primarily serve students that attend schools with a high concentration of low-income students, giving priority to applicants serving children in high-priority schools. Therefore, applicants must propose services only to schools with 30 percent or more of the students enrolled eligible for free or reduced priced meals. Priority will be given to the following:

schools that are eligible for Title I school wide programs, communities with more than 50 percent census poverty, WVDE state system of support Tier 1, Tier 2 and Tier 3 schools and others

not meeting adequate yearly progress (AYP),

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joint submissions (applications) from a local county board of education and a non- profit agency, city or county governmental agency, faith-based organization, higher education institution or for-profit corporation and

services to middle school and/or high school students.

WHAT IS THE DEADLINE FOR SUBMISSION OF APPLICATIONS?

Eligible applicants must submit their original application, four copies and an electronic copy before Friday, April 29, 2011, at 3 p.m. to:

Dr. Marsha Bailes, Assistant Director Office of School Improvement

West Virginia Department of Education Building 6, Room 617

1900 Kanawha Boulevard, East Charleston, WV 25305-0330 mcbailes@access.k12.wv.us

HOW AND WHEN WILL APPLICATIONS BE REVIEWED?

WVDE will conduct a 21stCCLC application review process in May, 2011, and make grant-award announcements in June, 2011, with funding expected to begin July 1, 2011. Participation in this Bidders’ Conference is required to submit an application.

For general 21st CCLC information, go to: www.ed.gov/21stcclc For West Virginia 21st CCLC grant program information, go to the West Virginia Department of Education website at: http://21stcclc.k12.wv.us/

GENERAL APPLICATION GUIDELINES

Intent to apply - Applicants are asked to notify WVDE by February 25, 2011, of their intent to apply for the next competition of five-year 21stCCLC funding (although it is not mandatory or binding to do so). Please contact Marsha Bailes at: mcbailes@access.k12.wv.us or call (304) 558-3199 phone.

Application Review – WVDE will utilize a review process using individuals with diverse background and expertise to evaluate the applications. Grant Award Decisions - WVDE reserves the right to not award all grant monies and/or to negotiate specific grant amounts. All awards are subject to the availability

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of federal funds. The WVDE may apply other factors in making funding

decisions, such as: (1) geographical distribution; (2) duplication of effort; (3)

duplication of funding; (4) evidence that an applicant has/has not performed

satisfactorily on previous projects; (5) prioritization based on the State Board

of Education strategic goal and initiatives. Grants are not final until a WVDE

grant contract is fully executed.

HOW TO PREPARE AN APPLICATION FOR A 21ST

CCLC GRANT

The following information describes eligibility, required activities, application contents and application review criteria.

Applications must comply with the following format: the application narrative section must not exceed 30 typed and numbered

pages, (not including appendices) using a 12-point font, double line spacing, with one-inch margins;

chart format may be used in appropriate sections; the application must be on plain white paper (one side only) held together

with a binder clip or stapled (no notebooks or coverings) and must not include unsolicited designs, headings, appendices, news clippings or other materials; and

the application should respond to the exact sequence, outline form, headings and information requested herein.

To be eligible for 21st CCLC funding, a completed 21st CCLC application should contain all the following sections in the sequence provided: 1. Cover Pages The applicant must provide all contact and descriptive information requested on the three required cover pages. These pages must be the first three sheets of the application. (see pp.17-18). 2. Application Checklist

Include a copy of the completed checklist (see page 19). 3. Project Summary and Abstract Complete the required Project Summary and Abstract form describing the community needs being addressed, the participants to be served, the program objectives, the activities proposed to meet the objectives, the intended outcomes, program evaluation activities and all other requested information. (See pp. 20-21).

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4. Table of Contents Include a table of contents with all sections and page numbers clearly identified for the application reviewers. 5. Application Narrative Use the guidelines on pages 9-15 of this document to describe how:

activities will be designed to assist low achieving students to meet state and local standards in core academic areas,

partnering organizations will collaborate and the project will meet the 21st CCLC application requirements.

6. Budget Complete a WVDE Budget Form (see p. 22) for each of the first three years of the project. Applicants must describe a multi-year project, but provide a formal

budget only for the first 12 months. Projects reporting successful implementation are asked to provide continuation applications and budgets for subsequent years if federal funding continues. Be sure to include line items in the budget for the following:

at least two project staff members to attend two WVDE-sponsored meetings in the fall and spring on specialized professional development meetings based upon need for technical assistance. (Note - registration cost is approximately $250 per person plus travel, food and lodging).

at least two people (the project director, a community-based person, and or school-based person) at a national conference providing training on effective before school, after school and summer school programs. Examples include: Foundations, Inc., The National Community Education Association, BOOST or the Us Department of Education 21st CCLC Summer Institute. Registration cost is approximately $300 per team plus travel, food and lodging.

background checks for out-of-school time staff and regular volunteers.

Note: Grant funds cannot be used to purchase facilities or vehicles, or support

construction.

7. Budget Narrative (see sample pp. 23-24). Provide a detailed budget narrative for the first year that clearly explains:

the mathematical basis for estimating the costs of professional personnel salaries, benefits, project staff travel, student transportation, materials and supplies, consultants and subcontracts, indirect costs and other project expenditures;

how the major cost items relate to the proposed activities and

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a detailed description explaining in-kind support and/or funding/resources provided by partners in the project.

8. Assurances Forms (see pp. 25-33). Attach the properly signed and completed assurances forms. 9. Appendices Attach only the following Appendices:

a list of collaborating partners with contact names, addresses, year-round telephone numbers, fax numbers, and e-mail addresses,

a memorandum of understanding or partner letter that clearly documents the

role and contribution of the partner and is not a generic letter of support,

a summary of any evaluation studies, reports, or research that documents the effectiveness or success of the collaborating partners and of the activities and services proposed in the narrative section of the application and

a copy of the applicant’s most recent audit to show evidence of accurate

accounting procedures and appropriate use of funds.

Note: Reviewers will have a limited time to review applications and will focus only

on the required sections of your application and the appendices listed above.

Supplementary materials such as videotapes, CD-ROMs, files on disks, publications,

press clippings, testimonial letters, etc., will not be reviewed or returned to the

applicant.

APPLICATION NARRATIVE GUIDELINES

In the 30-page (maximum) narrative of your application, respond to the following „Required Application Information‟.

1.) Need for Project (15 points) (Reapplying organizations must provide

data and detailed evidence of having met the objectives of their last 21st

CCLC grant.)

Describe the needs of students at risk of educational failure in your community, including:

results of a current local community needs survey (within the last 3 years) showing the gaps in the services that are available,

relevant needs data regarding the family members of the students to be served and

a description of the needy students the project will serve. Include: - data on their risk of educational failure, - local poverty rates, - number of students in WVDE State System of Support Tier 1, Tier 2

and/or Tier 3 schools and others not meeting Adequate Yearly Progress

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(AYP) under the No Child Left Behind Act of 2001, - percentage of Title I students, - dropout rates, - literacy rates and - educational levels in the community.

2.) Performance Objectives (10 points) list the measurable objectives the proposed project will use to remedy the risk

factors (needs) described for the target populations. those applicants who have previously received 21

st CCLC funding, MUST

provide data and detailed evidence documenting the improvement of

student achievement during the previous cycle of 21st CCLC funding.

These are Federal Targets to be considered when developing program objectives.

Federal Target* Forty-eight percent of students participating in this program will improve their

reading and language arts grades. Forty-eight percent of students participating in this program will improve their mathematics grades. Seventy-five percent of students participating in this program will demonstrate improvement in homework completion and class participation. Seventy-five percent of students participating in this program will demonstrate improvement in behavior. Eighty-five percent of out-of-school time centers emphasize programming in at least

one core academic subject area. Eighty-five percent of out-of-school time centers offer academic enrichment and support activities related to technology.

Eighty-five percent of out-of-school time centers offer academic enrichment, support activities, and programming to support student learning outside of core subject areas and technology.

* Federal Targets are subject to change based on federal guidelines.

3.) Project Activities & Implementation (40 points) ( Identify scientifically based research that provides evidence that the programs or activities you include in this section will help students meet state and local student academic achievement standards)

Tell what sources of student data that will be used to identify students who will benefit from expanded learning time.

Explain the recruitment strategy the program will use to enroll students in need of extended learning time.

Describe how program services in centers will be available to any

participating student a minimum of four days per week and 25 weeks per

year. Include an implementation timeline of major project activities.

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Provide a detailed plan of how your project staff will collaborate with

regular school day teachers and administrators to identify areas in for

individualized student assistance in academic areas as needed.

Describe the student attendance policy for the proposed 21st CCLC program. Explain how project staff will vary their approaches to help meet the

individual needs of students and improve their achievement in core academic areas to meet or exceed local and state standards.

Indicate specific activities that address the needs of potential dropouts and students otherwise at risk of academic failure, including students living in poverty and students with limited English proficiency.

Include the steps you propose to ensure equitable access to, and participation by, students, program personnel, family members and other program beneficiaries with special needs.

Describe opportunities for academic improvement including providing tutorial services to help students, particularly students who attend high-priority. Schools, meet state and local student performance standards in core academic subjects, such as reading and mathematics.

Explain how the program will use a diverse array of additional services, programs and activities, such as youth development activities, drug and violence prevention programs and counseling programs that are aligned with the needs of the particular population to be served.

Outline how the program will utilize science, technology, engineering and mathematics (STEM). The US Department of Education defines STEM education programs as “those

primarily intended to provide support for, or to strengthen, science, technology, engineering, or mathematics (STEM) education at the elementary and secondary through postgraduate levels, including adult education.” (US DOE, Report of the

Academic Competitiveness Council, 2007, p. 10). Describe how the proposed program will provide problem based or project

based learning activities that support state and local learning standards and contribute to academic performance for all students.

Tell how the program will offer a diverse array of art, music, recreation, technology education and character education programs that are designed to reinforce and complement the regular academic program of participating students.

Describe how the proposed program will involve the training of students in entrepreneurial skills. Entrepreneurship Cultivate student entrepreneurial skills through an organization like the Corporation for Enterprise Development/Rural Entrepreneurship through Action Learning (CFED/REAL) that meets the national accreditation standards of the Consortium of Entrepreneur Education. CFED/REAL is a national not-for-profit whose mission is to help individuals, schools and communities grow through hands-on entrepreneurship education. They have curriculum materials; instructor training; and help identify

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funding, on-site support technical assistance, and evaluation. For more information, go to: www.cfed.org/ and www.realenterprises.org/. Other entrepreneurial skill development initiatives may be proposed instead of or in addition to CFED/REAL participation.

Describe how the proposed program will involve civic engagement. Community Service Highly successful K-12 programs combine community service, civic engagement, service learning, and academic achievement. Activities allow students to identify, organize and complete community projects to gain educational proficiency, practical experience, improve their schools and communities and build citizenship. These activities may be coordinated with existing programs such as: school clubs, Boys & Girls Clubs, Learn & Serve West Virginia programs (http://learnandserve.k12.wv.us/), YMCA programs and other service organizations.

Describe plans for implementing summer programs, if applicable.

Note: The latest start date for every program is Monday, October 3, 2011. Each

site must be up and running on or before this date. A mandatory pre-site meeting

with WVDE Staff, program director, site coordinator, community partners and

principal of the schools of participating students needs to be scheduled prior to the

start of the program. 4.) Collaboration (10 points)

Describe the partnership between a local educational agency and community-based, faith-based, or other public or private organization(s).

Explain how the project was developed and will be carried out in active collaboration with the schools the students attend. Those applicants who

have previously received 21st CCLC funding must describe evidence of

collaboration between their previously funded program and the school’s

students attended. Describe the prior experience and/or capacity of the lead organization and

each major partner to provide educational and related activities that will complement and enhance the academic performance, achievement, and positive youth development of students. Those applicants that have

previously received 21st CCLC funding must be specific about how the

earlier program utilized partnering organizations to enhance academic

performance, achievement and positive youth development of students. Attach Memoranda of Understanding or partner letters that clearly

indicates the role, capacity and specific contributions of each partnering organization.

Note: the U.S. Department of Education and the West Virginia Department of

Education, strongly encourage joint applications that include a local county board

of education (school district).

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5.) College & Career Readiness (10 points) Describe how the project program will support school, college and workforce readiness. Also list descriptions of any off-site educational and/or enrichment activities that connect to the purpose and priorities of this grant (internships, college visits, college nights, job shadowing, etc.) for each site. The description should include information regarding the benefits of the proposed activity.

6.) Facility Plan (10 points) Describe how the environment will be welcoming, stimulate curiosity and

learning and provide space to exhibit students‟ work and projects. Tell how the program will ensure that the students will travel safely to and

from the 21st CCLC and home from school–based and/or off- site programs. Tell how the emergency exit plan will be communicated to the students in the

program. Describe how staff, students and parents are informed of the program‟s

emergency readiness plan. 7.) Program Personnel (15 points)

Describe procedures for managing the project. Use a chart to describe the staff structure (roles and responsibilities). Include

position descriptions for key community and school staff. Due to hiring requirements and personnel procedures, it is not necessary to name in the application a specific person to serve as the project director. However, position descriptions for the personnel you intend to employ with the 21st CCLC funding should be included.

Describe plans and budget for on-going staff training for the project. Expenses may include payment of staff for time to plan and attend the training and for hospitality.

Describe how qualified volunteers will be used to support proposed activities. Describe plans to ensure that selected staff working directly with students are

certified in both CPR and first aid (within two months of employment).

8.) Reasonable Cost for Project (5 points) Describe how the budget is reasonable in relation to the number of persons to

be served, services to be provided and anticipated results and benefits. The budget and budget narrative will be judged against the scope of the project and its anticipated benefits.

Explain how the project will ensure that funds will not be used to supplant federal, state, local or non-federal funds. Funds in the project must be used to increase the above mentioned funds that would, in the absence of these funds, be made available for authorized programs and activities.

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Note: Applicants that choose to establish a fee structure must provide a narrative

that explains the fee structure and how you will assure that income and or ability to

pay will not deter families from enrolling their children in the program.

Additionally, describe how the funds will be administered and managed.

9.) Sustainability (10 points) Since grant funding is intended as an incentive to promote the long-range establishment of out-of-school-time community programs, the application must include the following:

A reasonable plan for sustaining the community learning center(s) after grant funding ends.

A description of how you will leverage other sources of funding to supplement the grant award and to support services.

A description of how you will coordinate with other federal, state and local programs with compatible/complimentary services (i.e. Title I, Adult Basic Education, and Supplemental Education Services, etc.)

10.) Parent, Family and Community Involvement (15 points) Describe the activities that will include parents and families of students

who will receive services from the program. These activities MUST be aimed at improving the skills of parents or at supporting the connection between parents and their children‟s learning needs.

Describe initiatives that will involve parents in their children‟s learning,

either at home, at programs sponsored by the center, or elsewhere. Describe how students and parents will be involved in planning,

implementation, program evaluation and decision-making in the program Explain how your program will disseminate information about the center

(s) (including their location) to the community in a manner that is understandable and accessible.

Tell how the local community will actively engage in providing services to program participates and their families.

11.) Project Evaluation (15 points) Indicate how your objectives relate to the intended outcomes of the project

and how the program will collect reliable, valid quantitative and qualitative data to realistically verify student academic performance and accomplishments.

Explain how the staff will collaborate with regular school day teachers to assess and measure student needs and progress.

Grantees are required to participate in mandated federal, state and local evaluation processes and procedures. These include, but are not limited to: PPICS data

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collection system mandated by the US Department of Education and their contracted agent for federal evaluation; state data collection system mandated by the West Virginia Department of Education and its evaluator, and local evaluation which includes participation in the West Virginia Department of Education 21st CCLC Peer Observation Process and in the West Virginia Department of Education yearly monitoring completed by the 21st CCLC Teacher/Instructional Coaches for the northern and southern regions of West Virginia. The results of the evaluation must be used to: (1) improve and strengthen the program, (2) refine the performance measures and (3) assess effectiveness of activities. Results must also be shared with WVDE and made available to the public upon request.

Applicants must budget a cost of $1,500 per year for completion of the

WVDE mandated Local Peer Observation Process as part of

requirements for local evaluation of the 21st CCLC program. No other

local evaluation is required for the 21st CCLC Programs. However,

programs may choose to participate in further evaluation processes at

reasonable costs Applicants must participation in the bi- monthly collection of data by the

WVDE to assure compliance of grantees.

Applications will be rated on how clearly the objectives (performance measures) are related to the intended outcomes of the project, and include the collection of reliable and valid quantitative and qualitative data.

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21ST

CCLC PROGRAM GOAL, OBJECTIVES AND INDICATORS

Project goal, objectives and performance indicators established under the federal Government Performance and Results Act (GPRA) for the 21st Century Community Learning Centers (21st CCLC) project require:

clear benchmarks (assessed annually or more often) to monitor progress toward specific objectives (e.g., stating how students will be involved regularly in what activities for six months in order to reach an objective relating to improved reading and/or math scores or grades after one year of involvement) and

outcome measures to assess impact on student learning and behavior, including but not limited to standardized test scores and quarterly report cards; and which may include teacher, parent, student surveys or interviews and other data collection instruments.

These federal requirements are met by grantee participation in the West Virginia Department of Education mandatory Local Peer Observation Process (at a cost of $1,500 per year clearly shown in budget) and the annual West Virginia Department of Education 21st Century Monitoring process. See example of the WVDE 21

st

CCLC Program 2009-2010 Monitoring Tool and WVDE 21st CCLC Local Peer

Observation Tool 2009-2010 can be found on the WVDE 21st CCLC website

http://wvde.state.wv.us/21stcclc/resources.html . These two processes and tools

satisfy the mandatory requirements of the local evaluation as designated by the West

Virginia Department of Education. All optional additional evaluation procedures

should be cost effective.

Federal regulations that apply to the 21st CCLC program are: the U.S Education Department General Administrative Regulations (EDGAR) in 34 CFR Parts 75, 77, 79, 80, 81, 82, 85, and 86, and (b) 34 CFR Part 299. The EDGAR regulations can be found on the Department‟s website:

http://www.ed.gov/about/offices/list/index.html?src+mr

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COVER PAGES

All blanks must be completed. If you have questions, contact Dr. Marsha Bailes at mcbailes@access.k12.wv.us, phone (304) 558-3199, or fax (304) 558-1834

WVDE 21

st Century Community Learning Centers Grant Application

School Years 2011-2016

Funds Requested County(s): Have you previously received 21st Century Community Learning Center funding from the West Virginia Department of Education? Yes____ No _____ Total number of students you expect to serve:______ Proposed cost per student:________ Did a representative of this applicant attend the 21st Century Community Learning Center Technical Assistance/Bidders‟ Conference sponsored by the West Virginia Department of

Education on Thursday, January 27, at the Days Hotel and Conference Center in Flatwoods, WV? Yes_____ Name and contact information ________________________ No_____ FEIN Number (Federal Employees Identification Number) West Virginia Vendor Number Proposed Project Dates / / / / start date end date Applying Agency:

Collaborating Community-Organization Partners

County School System (if included as a partner) Schools Served

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Local Project Title: Lead Agency Contact Person: Phone #: Fax #: e-mail: Address:

Fiscal Agency Contact Person: Phone # Fax #: e-mail: Address: Number of sites: _______ Number of collaborating partners actively involved in the project

Schools Community-Based Organizations ___Faith-Based Organizations ___community/business ___Other (list)

Estimated Cost per Title I Student served (per year) $

Matching (local) funds: (none required) In-kind $ Cash $ Other (list) Date: ____________________ Agency Head‟s/Superintendent‟s Signature* *Signature indicates that applicant agrees to all conditions in the proposal. Note: If parts of the application are missing (or out of sequence), the application will not be reviewed or considered for funding approval (i.e. cover pages, budgets for the first three years of the 21st CCLC program, budget narrative, memoranda of understanding with collaboration partners, five identical copies submitted).

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APPLICATION CHECKLIST FORM

One original, four hard copies and an electronic copy of the application must be received by

3:00 p.m., Friday, April 29, 2011, at the office of Dr. Marsha Bailes, Assistant Director, Office of School Improvement, West Virginia Department of Education, Building 6, Room 617, 1900 Kanawha Boulevard, East, Charleston, WV 25305. A complete application must include the following in the order below. Check each of the following items as they are completed 1.) Cover Pages, fully completed and signed by an authorized official. 2.) Application Checklist completed 3.) Program Summary and Abstract 4.) Table of Contents 5.) Program Narrative - no more than 30 pages double-spaced 6.) Budget - a completed West Virginia Department of Education Form for years 1, 2 & 3

of requested funding 7.) Budget Narrative (1st year only) - the mathematical basis for estimating the costs of

professional personnel salaries (providing direct services), benefits, project staff travel, materials and supplies, consultants and subcontracts, indirect costs, and any projected expenditures

8.) The required Assurances, Certifications, and Disclosure forms (must be signed by an authorized official).

Non-Construction Programs (Form OMB 424B) The certification regarding lobbying; debarment, suspension and other responsibility

matters and Drug-free workplace requirements (Form ED-80-0013)

9.) The Appendices, providing only: (a) a list of consortium members or partners, with

contact information (b) memoranda of understanding or letters; (c) evidence/documentation of previous success (if applicable); (d) copy of most recent audit report.

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WV 21ST

CCLC PROJECT SUMMARY AND ABSTRACT FORM

Applicant Contact Information

Agency: Program Contact Person Name: Address: Phone: Fax: e-mail:

*Has the agency previously received 21st CCLC funding from the WVDE? _____Yes _____No

Student Populations to be Served (indicate number of schools in blank) ___ Elementary Schools ___ Middle Schools ___ High Schools ___ Title I schools ___ Low-performing Schools ___ Seriously-impaired Schools Total Number of Students to be Served:_____ Cost Per Student:_____________

Community Partners (indicate number in blank)

___ National Organizations (e.g., Boys & Girl Clubs,

YMCA/YWCA, Big Brothers/Big Sisters)

___ Community-Based Organizations (local non-

profits or foundations)

___ Libraries or Museums ___ Businesses

___ County or Municipal Agencies (e.g., police, Parks & Recreation, Social Services)

___ Colleges or Universities ___ Faith-Based Organizations ___ Hospitals/Clinics/Health Providers ___ other __________________________

List the name of each partner with the 21st Century Community Learning Center Project

Services to be Provided (check all that apply)

Reading or Literacy Mathematics Science Art, Music, Dance,

Theater

Sports or Recreation Technology, Video or Media Community Service Cultural Activities, Social

Studies

Health, Nutrition Youth Development Services for Adults Other ___________

Times of Operation Before school After school Summer Weekend

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Page 2 -- Project Summary and Abstract

Name & location of each site that will

become a CLC

Days and times of program operation throughout week

Estimated total

number of students to be served

% of total students who

receive Free/Reduced Price Lunch

(Title I)

Estimated number of

Tier 1 students to be served

Estimated number of

Tier 2 students to be served

Estimated number of

Tier 3 students to be served

Estimated number of

family members to be

served

Mon Tues Wed Thur Fri Sat

Mon Tues Wed Thur Fri Sat

Mon Tues Wed Thur Fri Sat

Mon Tues Wed Thur Fri Sat

Mon Tue Wed Thur Fri Sat

Totals for the entire project program

Total estimate of students to be served ______

Average % of Free/Reduced Lunch students _________

Total estimate of Tier 1 students to be served _______

Total estimate of Tier 2 students to be served _____

Total estimate of Tier 3 students to be served ______

Total estimate of family members to be served ________

*Start date of each site is no later than Monday, October 3rd. Estimated number to be served does not refer to the total school population but to the estimated students likely to

participate in the program.

Abstract. In the space below, briefly describe your program‟s goals, services, activities, and planned participants. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Last Updated: January 31, 2011

WVDE – 21st CCLC GRANT BUDGET FORM

Complete a form for the 1st, 2

nd, and 3

rd years of your program

County Agency/School _____________ Financial Contact Person ______________________________________________ Complete Street Address _____________________________________________ Phone # Fax # E-mail ________________________

Federal Funding (Line Items) Staff performing tasks only for 21st CCLC Funds Requested Administrative

Salary (Program Director, Secretary, Administrative Assistant) $ _______ Fringe Benefits $ _______ Subtotal $ _______ Programmatic

Salary (Tutors, Site Coordinators) $ _______ Fringe Benefits $ _______ Supplies/consumables $ _______ Transportation $ _______ Travel reimbursement (meetings) $ _______ Training $ _______ Evaluation – WVDE Local Peer Observation Process (Include approximately $1,500 Cost To Grantees) $ _______ Rental $ _______ Other (describe) __________________________________________ $ _______ Subtotal $ _______ Indirect cost (school board rate or 6% maximum) $ _______

TOTAL FEDERAL FUNDING REQUESTED $ _______

Local Funding & Contributions (Line Items) Matching Funds (Cash & In-Kind costs not required, but encouraged) Salary (administrative) $ _______ Fringe Benefits $ _______ Salary (tutors) $ _______ Supplies/consumables $ _______ Transportation $ _______ Travel reimbursement (meetings) $ _______ Training $ _______ Evaluation $ _______ Rental $ _______ Other (describe) _____________________________________________ $ _______

LOCAL FUNDING CONTRIBUTIONS TOTAL $ _______

TOTAL PROGRAM BUDGET (FEDERAL + LOCAL) $ _______

_________________________________________________________ Date _____ Superintendent’s or Agency Director’s Signature

************************************************************************************** STATE USE ONLY

Federal Funds Approved $ Program Code _______________ Account # 8712-096 Revenue Code 04511 FIMS ID _________ Date_______________

State Agency’s Signature

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EXAMPLE BUDGET NARRATIVE ITEMS

Your proposal must have a budget narrative explaining each line item on your 2011-2012 Budget Form. List each of your requested budget items, whether it is federally funded or a local contribution, the purpose, and the math used to estimate it. Funding

Budget Item Type Examples of Funding Purposes and Calculations

Salary federal 1 project director x $2,500/month x 12 months = $30,000 + fringe benefits = $____

federal 1 staff x $20/hour x 5,400 hours = $108,000 + fringe benefits = $____

federal 2 VISTA workers x $10,000/year = $20,000 federal 1 aide x $10/hour x 5,400 hours = $54,000 + fringe benefits = $____ local 1 piano instructor x $100/day x 36 days = $3,600 provided by the Community Fine Arts Association local 1 AmeriCorps worker x $1,500/year = $1,500 provided by the Lion‟s Club local 1 Karate teacher x $100/day x 72 days = $7,200 provided by the local YWCA local 1 Dentist x $300/day x 72 days = $21,600 provided by the local Health Clinic local half time receptionist x 180 days x $50/day = $9,000 provided by the local school system Supplies and federal writing materials = $2,000 Consumables federal computer software = $2,300 (list items)

local copy paper – 1,000 reams x $6/ream = $6,000 provided by the local school system local gardening tools = $500 provided by the Neighborhood Garden Club local vegetable & flower seeds, plants & fertilizer = $700 provided by We-Grow-Em Landscape Company local 1,000 pine seedlings = $4,000 Sweet Acres Nursery Transportation federal Driver for field trips x $1,600/mo x 9mo = $14,400 local bus home for kids x $200/day x 180 days = $36,000 provided by local school system

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EXAMPLE BUDGET NARRATIVE ITEMS continued: Budget Item Type Examples of Funding Purposes and Calculations Travel federal 6 staff x 3 training sessions x $300/ trip = $5,400 federal 6 people x $300 workshop registration fee = $1,800 Evaluation local WVDE Local Peer Observation Process = $1,500 Equipment federal 6 computers/printers/monitors x $1,200 = $7,200 local miscellaneous classroom equipment = $5,000 provided by the Boys & Girls Club Rental/Lease federal photo copier x $200/month x 12mo = $2,400

federal facility utilities $.32 per KWH (use local utility rate) x 4,500-KWH x 9-months = $12,960

local school computer room x 1,600 ft2 x $6.00/ft2 per month x 9 months = $86,400

local school gymnasium x 2,400 ft2 x $6.00/ft2 per month x 9 months = $129,600

Other federal 6 field trips x $500/trip = $3,000

local tutors x 1,680-hours x $13.65 per hour = $22,932 provided by the Senior Citizen‟s Auxiliary local 6 craft consultants x $1,000/person = $6,000

Note: It is your responsibility to maintain documentation (for 5-years) to support your

expenditures.

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ASSURANCE FORMS

Lobbying, Debarment, Suspension, etc. form ED 80-0013

CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND

OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS

Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the instructions for certification included in the regulations before completing this form. Signature of this form provides for compliance with certification requirements under 34 CFR Part 82, "New Restrictions on Lobbying," and 34 CFR Part 85, "Government-wide Debarment and Suspension (Nonprocurement) and Government-wide Requirements for Drug-Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of Education determines to award the covered transaction, grant, or cooperative agreement. 1. LOBBYING As required by Section 1352, Title 31 of the U.S. Code, and implemented at 34 CFR Part 82, for persons entering into a grant or cooperative agreement over $100,000, as defined at 34 CFR Part 82, Sections 82.105 and 82.110, the applicant certifies that: (a) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making of any federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal grant or cooperative agreement; (b) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions; (c) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all subrecipients shall certify and disclose accordingly.

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2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS As required by Executive Order 12549, Debarment and Suspension, and implemented at 34 CFR Part 85, for prospective participants in primary covered transactions, as defined at 34 CFR Part 85, Sections 85.105 and 85.110-- A. The applicant certifies that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (2)(b) of this certification; and

(d) Have not within a three-year period preceding this application had one or more public transaction (federal, state, or local) terminated for cause or default; and

B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application. 3. DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS) As required by the Drug-Free Workplace Act of 1988, and implemented at 34 CFR Part 85, Subpart F, for grantees, as defined at 34 CFR Part 85, Sections 85.605 and 85.610 - A. The applicant certifies that it will or will continue to provide a drug-free workplace by: (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition; (b) Establishing an on-going drug-free awareness program to inform employees about: (1) The dangers of drug abuse in the workplace;

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(2) The grantee's policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will: (1) Abide by the terms of the statement; and (2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction; (e) Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to: Director, Grants Policy and Oversight Staff, U.S. Department of Education, 400 Maryland Avenue, S.W. (Room 3652, GSA Regional Office Building No. 3), Washington, DC 20202-4248. Notice shall include the identification number(s) of each affected grant; (f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted: (1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; (g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e), and (f). B. The grantee may insert below the site(s) for the performance of work done in connection

with the specific grant: Place of Performance (street address. city, county, state, zip code) Check if there are workplaces on file that are not identified here. DRUG-FREE WORKPLACE (GRANTEES WHO ARE INDIVIDUALS)

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As required by the Drug-Free Workplace Act of 1988, and implemented at 34 CFR Part 85, Subpart F, for grantees, as defined at 34 CFR Part 85, Sections 85.605 and 85.610- A. As a condition of the grant, I certify that I will not engage in the unlawful manufacture,

distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant; and

B. If convicted of a criminal drug offense resulting from a violation occurring during the

conduct of any grant activity, I will report the conviction, in writing, within 10 calendar days of the conviction, to: Director, Grants Policy and Oversight Staff, Department of Education, 400 Maryland Avenue, S.W. (Room 3652, GSA Regional Office Building No. 3), Washington, DC 20202-4248. Notice shall include the identification number(s) of each affected grant.

As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications. NAME OF APPLICANT:

PROJECT NAME:

PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE:

SIGNATURE: DATE:

ED 80-0013 10/08

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ASSURANCES - 2

Non-Construction form SF 424B

OMB Approval No. 0348-0040

ASSURANCES - NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503 Note: Certain of these assurances may not be applicable to your project or program. If you have

questions, please contact the awarding agency. Further, certain federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.

As the duly authorized representative of the applicant I certify that the applicant: 1. Has the legal authority to apply for federal assistance, and the institutional, managerial and

financial capability (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and completion of the project described in this application.

2. Will give the awarding agency, the Comptroller General of the United States, and if

appropriate, the state, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.

3. Will establish safeguards to prohibit employees from using their positions for a purpose that

constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain.

4. Will initiate and complete the work within the applicable time frame after receipt of

approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 004728-4763)

relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).

6. Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits

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discrimination on the basis of race, color or national origin; (b) Title IX of the Education -1683, and 1685-1686), which

prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of n the basis of

-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the

527 of the Public Health Service Act -3 and 290 ee 3), as amended, relating to confidentiality of

alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 lating to nondiscrimination in the sale, rental or

financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s) which may apply to the application.

7. Will comply, or has already complied, with the requirements of Titles II and III of the

uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of federal participation in purchases.

8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. 001501-1508 and

7324-7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with federal funds.

9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. 00276a to 276a-

-333), regarding labor standards for federally assisted construction subagreements.

10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of

the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.

11. Will comply with environmental standards which may be prescribed pursuant to the

following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved state management program developed

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under the Coastal Zone Management Act of 1972 (16 U.S.Cconformity of Federal actions to State (Clear Air) Implementation Plans under Section

of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205).

12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 001721 et seq.) related

to protecting components or potential components of the national wild and scenic rivers system.

13. Will assist the awarding agency in assuring compliance with Section 106 of the National

Historic Preservation Act of 1966, as amended (16 U.Sand protection of historic properties), and the Archaeological and Historic Preservation Act

-1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in

research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7

blooded animals held for research, teaching, or other activities supported by this award of assistance.

16. Will comply with the Lead-

seq.), which prohibits the use of lead-based paint in construction or rehabilitation of residence structures.

17. Will cause to be performed the required financial and compliance audits in accordance with

the Single Audit Act Amendments of 1996 and OMB Circular No. A-States, Local Governments, and Non-

18. Will comply with all applicable requirements of all other federal laws, executive orders,

regulations and policies governing this program.

NAME OF APPLICANT:

PROJECT NAME:

SIGNATURE:

DATE:

Standard Form 424B (Rev. 7-97) Back

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ASSURANCES - 3

GEPA Equitable Access form 1890-0007

OMB Control No. 1890-0007 (Exp. 09/30/2004) NOTICE TO ALL APPLICANTS The purpose of this enclosure is to inform you about a new provision in the Department of Education's General Education Provisions Act (GEPA) that applies to applicants for new grant awards under Department programs. This provision is Section 427 of GEPA, enacted as part of the Improving America's Schools Act of 1994 (Public Law (P.L.) 103-382). To Whom Does This Provision Apply?

Section 427 of GEPA affects applicants for new grant awards under this program. ALL

APPLICANTS FOR NEW AWARDS MUST INCLUDE INFORMATION IN THEIR

APPLICATIONS TO ADDRESS THIS NEW PROVISION IN ORDER TO RECEIVE

FUNDING UNDER THIS PROGRAM. (If this program is a state-formula grant program, a state needs to provide this description only for projects or activities that it carries out with funds reserved for state-level uses. In addition, local school districts or other eligible applicants that apply to the state for funding need to provide this description in their applications to the state for funding. The state would be responsible for ensuring that the school district or other local entity has submitted a sufficient section 427 statement as described below.) What Does This Provision Require? Section 427 requires each applicant for funds (other than an individual person) to include in its application a description of the steps the applicant proposes to take to ensure equitable

access to, and participation in, its federally-assisted program for students, teachers, and

other program beneficiaries with special needs. This provision allows applicants discretion in developing the required description. The statute highlights six types of barriers that can impede equitable access or participation: gender, race, national origin, color, disability, or age. Based on local circumstances, you should determine whether these or other barriers may prevent your students, teachers, etc. from such access or participation in, the federally-funded project or activity. The description in your application of steps to be taken to overcome these barriers need not be lengthy; you may provide a clear and succinct description of how you plan to address those barriers that are applicable to your circumstances. In addition, the information may be provided in a single narrative, or, if appropriate, may be discussed in connection with related topics in the application. Section 427 is not intended to duplicate the requirements of civil rights statutes, but rather to ensure that, in designing their projects, applicants for federal funds address equity concerns that may affect the ability of certain potential beneficiaries to fully participate in the project and to achieve to high standards. Consistent with program requirements and its approved application,

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an applicant may use the federal funds awarded to it to eliminate barriers it identifies. What are Examples of How an Applicant Might Satisfy the Requirement of This

Provision? The following examples may help illustrate how an applicant may comply with Section 427.

(1) An applicant that proposes to carry out an adult literacy project serving, among others, adults with limited English proficiency, might describe in its application how it intends to distribute a brochure about the proposed project to such potential participants in their native language.

(2) An applicant that proposes to develop instructional materials for classroom use might describe how it will make the materials available on audio tape or in Braille for students who are blind.

(3) An applicant that proposes to carry out a model science program for secondary students and is concerned that girls may be less likely than boys to enroll in the course, might indicate how it intends to conduct "outreach" efforts to girls, to encourage their enrollment.

We recognize that many applicants may already be implementing effective steps to ensure equity of access and participation in their grant programs, and we appreciate your cooperation in responding to the requirements of this provision. Estimated Burden Statement for GEPA Requirements

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1890-0007. The time required to complete this information collection is estimated to average 1.5 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the

accuracy of the time estimate(s) or suggestions for improving this form, please write to:

Director, Grants Policy and Oversight Staff, U.S. Department of Education, 400 Maryland Avenue, SW (Room 3652, GSA Regional Office Building No. 3), Washington, DC 20202-4248. NAME OF APPLICANT PROJECT NAME

PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE SIGNATURE DATE

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2011-2016 WV 21stCCLC APPLICATION RATING FORM

Reviewer Identification Code _____________ Points available 155 Total Points = _____/

County _______________________________ Agency ______________________________

Criteria 1 - Need for Project (15 Points) To receive a score of fifteen points, applicant must have described the needs of students at risk of educational

failure in their community, including: Results of a current local community needs survey (within the last 3 years) showing the gaps in the

services that are available and Relevant needs data regarding the family members of the students to be served. A description of the needy students the project will serve, including:

- data on their risk of educational failure, - local poverty rates, - number of students in WVDE-identified, low-performing or seriously impaired schools and

schools not meeting Adequate Yearly Progress (AYP) under the No Child Left Behind Act of 2001,

- percentage of Title I students, - dropout rates and - literacy rates - educational levels in the community.

Circle total number of points awarded below

Minimal/Weak The proposal seldom reflects a clear understanding and articulation of the criteria, is often confusing and generally gives the impression of a lack of understanding by the writers evidenced by the number of errors and (lack of) attention to details. Little research is evident.

1 2 3 4 5

Acceptable The proposal often reflects the clear understanding and articulation of the criteria. Errors are generally small and do not detract from the clarity of the criteria. The supportive research may at times be incomplete or irrelevant.

6 7 8 9 10

Extensive/Strong The proposal clearly defines the criteria in logical and effective manners. Errors are minimal or non-existent. The supportive processes are logical and reinforced by valid research.

11 12 13 14 15 Comments: __________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________