1 P age. READ THIS FIRST! 21st Century GAP *Section 5, Proposal Narrative Amended (28 pages maximum)

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1 807 21st Century Community Learning Center - Cohort 14 Fiscal Year: Milestone: Under OSPI Review (Printed 7/28/2017) Organization Code: ESD: Capital Region ESD 113 Page 1 READ THIS FIRST! 21st Century GAP *Section 5, Proposal Narrative Amended (28 pages maximum) Title I Eligible Schools - Only Title I Eligible and Title I Serving schools are eligible to apply Eligible Entity Partnership and Compliance with Program Assurances Determination of Eligible Entity Partnership An eligible entity partnership is a requirement for consideration for funding. The partnership must include a school district(s) or Local Education Agency (LEA) with designated high poverty schools that are Title I eligible, and at least one community-based organization, that is not primarily a contracted service provider. For the purpose of this grant an Educational Service District (ESD) is considered an LEA, and a partnership between an ESD and a school district, or two or more school districts would not be considered an eligible entity partnership, without the inclusion of a community based organization as a primary partner. Community-based organizations can include other public 1 P age

2 and non-profit agencies and organizations, businesses, educational entities (such as vocational and adult education programs, school-to-work programs, faith-based organizations, community colleges or universities), recreational, cultural and community service entities. Proposals must be jointly submitted by school districts and community-based organizations or other private or public entities. Only 1 application per school district is allowed in a single grant cycle. (Some rural remote schools may be exempt from the partnership requirement, upon request, and the provision of evidence that this requirement cannot be met within reasonable geographic proximity, and would prevent them from applying for this program funding.) Press the "NEW" button to complete information for each new record. To avoid losing data, press the "SAVE" button after completion of each new record. Allow save to complete before pressing the "NEW" button again. Instructions: REQUIRED In the space below there must be a minimum signature of 1 Superintendent and 1 Community Based Organization CEO, or representative. Print the signature page, sign it, and upload as an attachment on page 5. Name of Primary Partner Representative: (District Superintendent or Chief Executive Officer) Title of Authorizing Primary Partner Representative: Dr. Dana Anderson Superintendent Name of Organization or School District: Capital Region ESD 113 Signature: Uploaded to Attachments Telephone Number: Name of Primary Partner Representative: (District Superintendent or Chief Executive Officer) danderson@esd113.org Dr. Alex Apostle 2 P age

3 Title of Authorizing Primary Partner Representative: Name of Organization or School District: Signature: Superintendent Shelton School District Uploaded to Attachments Telephone Number: Date (MM/DD/YY): 7/19/2017 Instructions: REQUIRED In the space below there must be a minimum signature of 1 Superintendent and 1 Community Based Organization CEO, or representative. Print the signature page, sign it, and upload as an attachment on page 5. Name of Primary Partner Representative: (District Superintendent or Chief Executive Officer) Title of Authorizing Primary Partner Representative: Name of Organization or School District: Signature: Dr. Mary Garguile VPI Olympic College Uploaded to Attachments Telephone Number: Name of Primary Partner Representative: (District Superintendent or Chief Executive Officer) Title of Authorizing Primary Partner Representative: Name of Organization or School District: landerson@olympic.edu Ms. Ellen Shortt-Sanchez CCBLA Director Evergreen State College 3 P age

4 Signature: Uploaded to Attachments Telephone Number: Date (MM/DD/YY): 7/19/2017 Instructions: REQUIRED In the space below there must be a minimum signature of 1 Superintendent and 1 Community Based Organization CEO, or representative. Print the signature page, sign it, and upload as an attachment on page 5. Name of Primary Partner Representative: (District Superintendent or Chief Executive Officer) Title of Authorizing Primary Partner Representative: Name of Organization or School District: Signature: Mr. Bert Fisher President/CEO Our Community Credit Union Uploaded to Attachments Telephone Number: bfisher@ourcu.com Name of Primary Partner Representative: (District Superintendent or Chief Executive Officer) Title of Authorizing Primary Partner Representative: Name of Organization or School District: Signature: Telephone Number: 4 P age

5 Date (MM/DD/YY): 7/19/2017 Press the "NEW" button to complete information for each additional Partner. To avoid losing data, press the "SAVE" button after completion of each new Partner. Allow save to complete before pressing the "NEW" button again. 1. The partnership includes at least one Local Education Agency (LEA) or school district (with only designated high poverty, Title I eligible schools) and at least one community-based organization, that is not primarily an entity contracted to provide services to the project. A partnership is an entity with the primary partners making significant contributions to the grant goals and outcomes, providing either direct financial support or in-kind support, which is documented in the budget narrative. 2. The school district administration and at least one community based organization collaborated extensively in the planning and design of the program. 3. Each partner organization has substantial roles to play in the implementation of the program; delivery of services, program evaluation, and program improvement plans over the duration of the project. 5 P age

6 4. All partner organizations share program resources to carry out their roles, and contributions are reflected in the budget Narrative as in kind or direct support. 5. All partners have significant and ongoing involvement in the management and oversight of the program. 6. A formal Memorandum of Agreement among the partners and the fiscal agent has been signed that specifically states that the fiscal agent cannot act as flow-through for grant funds and does not subgrant to other recipients. For example, applicants are not permitted to subgrant a significant portion of their award to a single entity. 7. The Memorandum of Agreement also identifies all partner obligations and contributions for cash, direct service, or in-kind, as well as roles and responsibilities for oversight supervision and management of the project. 8. Priority for funding will be given to partnerships that provide evidence of collective planning, implementation, evaluation, and planning for sustainability. 9. Applications submitted without evidence of an eligible entity partnership, a formal Memorandum of Agreement, and/or a formal Data Sharing Agreement will not be considered for funding. To be considered as a viable eligible entity partnership, there must be evidence that: 6 P age

7 Compliance with Program Regulations I certify that to the best of my knowledge and belief, information provided in this application is true and correct, the document has been duly authorized by the governing bodies of the eligible entity partnership applicants, and the applicants agree to comply with the attached assurances and general assurances under the Elementary and Secondary Education Act (ESEA), as amended by the Every Student Succeeds Act (ESSA) of 2015; and the terms of the proposal if the proposal is approved for a grant award. Before completing this certification, please read assurances carefully. By signing the Certificate of Assurances, the duly authorized representatives of the eligible entity partnership certify that the partnership will comply with the assurances pertinent to all applicants and to programs for which the applicant is applying, including but not limited to: Compliance with all federal requirements of the federal 21st Century Community Learning Centers as detailed in Title IV, Part B of the Elementary and Secondary Education (ESEA) Act of 2001, as amended by the Every Student Succeeds Act (ESSA) of 2015 and general provisions. The applicant assures to the best of his/her knowledge and belief that the data in this application are true and correct and that the filing of the application has been duly authorized by the governing board of the applicant and that the applicant will comply with the required assurances if funding is approved. Projects are required to sign the Certificate of Assurances, certifying that the applicant will comply with the assurances pertinent to all applicants and to programs for which the applicant is applying. The applicant also certifies that they will comply with the general assurances listed in the consolidated state application (igrants). 1. An assurance that the program will take place in a safe and easily accessible facility. 2. An assurance that the proposed program was developed, and will be carried out; in active collaboration with the schools that participating schools attend (including through the sharing of relevant data among the schools), all participants of the eligible entity, and any partnership entities described in subparagraph (H), in compliance with applicable laws relating to privacy 7 P age

8 and confidentiality, and in alignment with the challenging State academic standards and any local academic standards. 3. An assurance that there will be no barriers to participation by qualifying students. 4. An assurance that the program will primarily target students who attend schools eligible for schoolwide programs under Section 1114 of the ESEA and the families of such students. Enroll students who may be at risk for academic failure; dropping out of school, involvement in criminal or delinquent activities, or who lack strong positive role models, and the families of students described in section An assurance that funds under this part will be used to increase the level of state, local, and other non-federal funds that would, in the absence of funds under this part, be made available for programs and activities authorized under this part, and in no case supplant federal, state, local, or non-federal funds. 6. An assurance that the applicant has sought out public comment on the 21st Century Community Learning Center grant proposal before submission, especially from those parents whose children are proposed to be served by the program, and has considered such comments in the development of the application. 7. An assurance that staff time paid through the 21st Century Community Learning Centers funding is fully dedicated to the 21st Century Community Learning Center. 8 P age

9 8. The applicant will comply with all federal and state statutes and administrative regulations and all program plans and applications, which are applicable to this program. 9. The applicant will use fiscal control and fund accounting procedures that will ensure proper disbursement of, and accounting for, federal funds paid to the applicant under the program and in the event of an audit exception, shall repay federal funds upon completion of audit resolution. 10. The applicant agrees to adopt and use proper methods of administering this program, including but not limited to: (1) the enforcement of any obligations imposed by federal statutes and administrative rules on the applicant responsible for carrying out this program and (2) correcting any deficiencies in program operations that are identified through audits, monitoring, or evaluation. 11. The applicant agrees to provide all information as directed or as requested by the Office of the Superintendent of Public Instruction, the Secretary for the U.S. Department of Education, and other federal officials for audit, program evaluation, compliance, monitoring, and other purposes; and to maintain all records for the current year. 12. The applicant certifies that no funds have been paid to any person to influence an officer or employee of any federal or state department or agency. 9 P age

10 13. The applicant agrees to provide all student data required for state and federal reporting. (If non-profit or faith-based agency a data sharing agreement has been developed.) 14. The applicant agrees to participate in any quality program assessment required by OSPI. 15. The applicant will provide a current signed data-sharing agreement between all partners in the appendices that will be implemented between the school districts and agencies providing service to ensure that pertinent student specific data, academic records, student achievement results, and student surveys are collected, shared, and accurately submitted to the federal data reporting system in a timely manner. Data sharing is an integral and required element of effective program partnerships. 21st Century Community Learning program grants are awarded on a competitive basis after thorough review by a committee, with funding based on need as well as quality of proposal. I understand that any proposal selected for funding is to be implemented as written in the original proposal. If substantial programmatic changes which result in altering the intent of the originally funded proposal are made during the course of the grant period, funds may be withheld. All requests for program changes must be formally approved by OSPI. Page 2 Program Profile 10 P age

11 Grantee Name: Capital Region ESD 113 Grant Request Amount: $352,638 What school districts will be served by this project? Shelton School District If you were a previously funded project, what year was the grant awarded? 2010 What priorities for funding does this grant application propose to meet and has demonstrated evidence in the program proposal? A. Schools Proposing to serve: 1. Highest levels of poverty, 80% or more based off the Free and Reduced-price lunch eligibility. 2. Highest percentage of students not meeting proficiently in literacy and mathematics. 3. Title 1 Participating School. 4. Identified as a Priority or Focus School. 5. Applications that target populations of students and families with a high percentage of racial and ethnic minorities (more than 80%) including; Hispanic/Latino, American Indian/Alaskan Native, Asian, Black/African American, Native Hawaiian/ Other Pacific Islander, and Two or More Races. 6. Evidence of an unmet need for out of school time services in the community. B. Program Activities that: 1. Provide after-school activities for students who are English Learners that emphasize language skills and academic achievement. 2. Partner with in-demand fields of the local workforce or build career competencies and career readiness and ensure that local workforce and career readiness skills are aligned with the Carl d. Perkins Career and Technical Education Act of 2006 (20 U.S.C et seq.) and the Workforce Innovation and Opportunity act (29 U.S.S et. Seq.). 11 P age

12 3. Provide literacy education programs, including financial literacy programs and environmental literacy programs. 4. Build skills in science, technology, engineering, and mathematics, (STEM) including computer science, and that foster innovation in learning by supporting nontraditional STEM education teaching methods. Evidence of funding priorities for specific populations and activities must be clearly demonstrated in the Profile Page, The Narrative, Need Statement, and Quality of Project Design Sections. Regular School Year Program Programs are required to be operational September through the end of the school district calendar. What months will your school year program be in operation? September-June WHAT ARE THE PARAMETERS OF YOUR REGULAR SCHOOL YEAR PROGRAM? Press the "NEW" button to complete a record for each site. To avoid losing data, press the "SAVE" button after completion of each new record. Allow SAVE to complete before pressing the "NEW" button again. Site Profile Site Name? Evergreen Elementary School Based? Yes Community Based Center? No 12 P age

13 Address where services are provided: 900 W. Franklin St, Shelton, Wa Name of School Building(s) served: Evergreen Elementary School Building Address: 900 W. Franklin St, Shelton, Wa School District Address: 700 S. 1st Street Shelton, Washington Building Code(s): 2745 Student Services School Year Hours/D ay Hours/We ek Weeks/Ye ar Grade s Serve d Numbe r Enrolle d in 21st CCLC Average Daily Attendan ce Studen ts Served 30 Days or More Studen ts Served 60 Days or More Previou s 21st CCLC Fundin g? Title I School Servin g? (For OSPI Use Only) % Free and Reduce d Lunch (For OSPI Use Only) K No Yes 91% Percentage of Students Not Proficient in Reading and Math (relevant to the building that is associated with your site) 13 P age

14 Pct Not Proficient in Reading (For OSPI Use Only) Pct Not Proficient in Math (For OSPI Use Only) OSPI will assign the averaged weighted score (For OSPI Use Only) 73% 76% 75% Adult Services Hours/Day Hours/Week Days/Month Weeks/Year Number Enrolled in 21st CCLC Average Daily Attendance Number Attending 7 Days or More Site Profile Site Name? Olympic Middle School School Based? Yes Community Based Center? No Address where services are provided: 800 E K. St. Shelton, Wa Name of School Building(s) served: Olympic Middle School Building Address: 800 E K. St. Shelton, Wa P age

15 School District Address: 700 S. 1st Street Shelton, Washington Building Code(s): 4586 Student Services School Year Hours/D ay Hours/We ek Weeks/Ye ar Grade s Serve d Numbe r Enrolle d in 21st CCLC Average Daily Attendan ce Studen ts Served 30 Days or More Studen ts Served 60 Days or More Previou s 21st CCLC Fundin g? Title I School Servin g? (For OSPI Use Only) % Free and Reduce d Lunch (For OSPI Use Only) Yes Yes 71% Percentage of Students Not Proficient in Reading and Math (relevant to the building that is associated with your site) Pct Not Proficient in Reading (For OSPI Use Only) Pct Not Proficient in Math (For OSPI Use Only) OSPI will assign the averaged weighted score (For OSPI Use Only) 52% 56% 54% Adult Services 15 P age

16 Hours/Day Hours/Week Days/Month Weeks/Year Number Enrolled in 21st CCLC Average Daily Attendance Number Attending 7 Days or More Summary of Site Profile(s) School Year Summary of Student Services for all site(s) Student Services Averag e Hours/ Day Average Hours/ Week Average Weeks/ Year Grad es Serv ed Add Num ber Enroll ed in 21st CCLC Averag e Daily Attenda nce Add Stude nts Serve d 30 Days or More Add Stude nts Serve d 60 Days or More Previo us 21st CCLC Fundi ng? Title I Schoo l Servi ng? (For OSPI Use Only) % Free and Redu ced Lunch (For OSPI Use Only) Race/ Ethnic ity (For OSPI Use Only) Avera ge Weigh ted Not Profici ent Readi ng (For OSPI Use Only) Avera ge Weigh ted Not Profici ent Math (For OSPI Use Only) Average Weighted Not Proficient Reading/ Math (For OSPI Use Only) N/A N/A Yes 81% 63% 59% 62% 61% Summer Program Summer programs must be a MINIMUM of 4 weeks, 20 hours a week, a total of 80 hours. What months will your summer program be in operation? July/August 16 P age

17 WHAT ARE THE PARAMETERS OF YOUR SUMMER PROGRAM? Press the "NEW" button to complete a record for each site. To avoid losing data, press the save button after completion of each new record. Allow save to complete before pressing the "New" button again. Site Profile Site Name? Evergreen Elementary School School Based? Yes Community Based Center? No Address where services are provided: 900 W Franklin St, Shelton, WA Name of School Building(s) Served: Evergreen Elementary School Building Address: 900 W Franklin St, Shelton, WA School District Address: 700 S. 1st Street Shelton, Washington Building Code: 2745 Student Services Summer 17 P age

18 Hours/Day Days/Week Weeks/Year Grades Served Projectd Number Enrolled in 21st CCLC Average Daily Attendance Students Served 20 Days or More Adult Family Members Served K Site Profile Site Name? Olympic Middle School School Based? Yes Community Based Center? No Address where services are provided: 800 E K St Shelton WA Name of School Building(s) Served: Olympic Middle School Building Address: 800 E K St Shelton WA School District Address: 700 S. 1st Street Shelton, Washington Building Code: 4586 Student Services Summer 18 P age

19 Hours/Day Days/Week Weeks/Year Grades Served Projectd Number Enrolled in 21st CCLC Average Daily Attendance Students Served 20 Days or More Adult Family Members Served Summary of Summer Profile(s) Average Hours/Day Average Days/Week Average Weeks/Year Grades Served Add Projectd Number Enrolled in 21st CCLC Average Daily Attendance Add Students Served 20 Days or More Add Adult Family Members Served N/A What activities will be provided to students and families? Press the "NEW" button to complete a record for each site. To avoid losing data, press the "SAVE" button after completion of each new record. Allow SAVE to complete before pressing the "NEW" button again. 19 P age

20 Page 3 Budget Narrative Note: The budget narrative below does not replace the official budget matrix to be completed at a later date after finalists have been notified. All Purchased Services need to be clearly delineated in the middle column. The Direct charges to the grant as well as Purchased Services will automatically be totaled for you. Therefore, totals from direct charges and purchased services should equal your total grant amount requested. The budget narrative is awarded points, and an accurate and detailed cost calculation for each budget object is required. Cost Calculation Direct Charges to Grant Amount Purchased Services (name provider) Total of Direct Charges and Purchased Services Cash Value of Partner Contributions (name partner) Certificated/Classified Staff $ Amt: $30,650 Site 1 Evergreen Elementary 1).5 FTE Site Coordinator: figured at a salary of $48,089 ($23.12/hr) for 1.0 FTE becomes $24,045 for a.5 FTE. Site coordinators coordinate building programs, hire and supervise staff, attend school staff meetings, collaborate with partners for sustainability planning, coordinate parent literacy events in collaboration with partners, and work with parents individually to reduce $215,191 $ Amt: $215,191 Olympic College will provide $15,350 in staff support to provide parent ESL classes, childcare, and AVID-style classes for parents and students. ESD 113 Student Assistance Program will 20 P age

21 attendance barriers. Cost: $24, ) Academic Coaches: figured at $21.00 per hour, for 3 hours per day Monday through Thursday for afterschool programming and 4.0 hours per day Monday through Friday for 4 weeks for summer programming as well as 2) 8 hour days annually for professional development. Academic coaches are teachers who provide direct instruction to students, plan academic and enrichment lessons, coordinate lesson plans to enhance school day curriculum, and work with parents of students to identify individual needs. Cost: $40, ) Assistant Academic Coaches: figured at $13.00 per hour, for 3.25 hours per day Monday through Thursday for afterschool programming and 4.25 hours per day Monday through Friday for 4 weeks for summer programming as well as 2) 8 hour days annually for professional development. Assistant Academic Coaches assist in direct instruction to students, and organize activities in conjunction with other site staff. provide staffing for Strengthening families programming ($2,000.00). The Shelton School District will provide $8,300 in parent engagement and education supports as well as staff to provide tutoring in both math and reading. The Evergreen State College will provide staffing for math and reading tutoring as well as project based learning activities ($ ). 21 P age

22 Cost: $26, ) Mentor/Tutors: figured at $11.00 per hour, for 3 hours per day Monday through Thursday for afterschool programming and 4.25 hours per day Monday through Friday for 4 weeks for summer programming as well as 2) 8 hour days annually for professional development Mentor/tutors will work with students to provide support to students, provide enrichment activities, program support, and engage with parents during program hours. Cost: $10, Site 2 Olympic Middle School 1).5 FTE Site Coordinator: figured at a salary of $48,089 ($23.12/hr) for 1.0 FTE becomes $24, for a.5 FTE. Site coordinators coordinate building programs, hire and supervise staff, attend school staff meetings, collaborate with partners for sustainability planning, coordinate parent literacy events in collaboration with partners, and work with parents individually to reduce attendance barriers. Cost: $24, ) Academic Coaches: figured at $21.00 per hour, for 3 22 P age

23 hours per day Monday through Thursday for afterschool programming and 4.0 hours per day Monday through Friday for 4 weeks for summer programming as well as 2) 8 hour days annually for professional development Academic coaches are teachers who provide direct instruction to students, plan academic and enrichment lessons, coordinate lesson plans to enhance school day curriculum, and work with parents of students to identify individual needs. Cost: $20, ) Assistant Academic Coaches: figured at $13.00 per hour, for 3.25 hours per day Monday through Thursday for afterschool programming and 4.25 hours per day Monday through Friday for 4 weeks for summer programming as well as 2) 8 hour days annually for professional development. Assistant Academic Coaches assist in direct instruction to students, and organize activities in conjunction with other site staff. Cost: $13, ) Mentor/Tutors: figured at $11.00 per hour, for 3 hours per day Monday through 23 P age

24 Thursday for afterschool programming and 4.5 hours per day Monday through Friday for 4 weeks for summer programming as well as 2) 8 hour days annually for professional development Mentor/tutors will work with students to provide support to students, provide enrichment activities, program support, and engage with parents during program hours. Cost: $10, Administration 1).50 FTE Project Director (Student Support Coordinator): figured at a salary of $66,291.00($31.87/hr) for 1.0 FTE becomes $33, for.5 FTE. This position will serve as the Project Director of this grant and be responsible for ensuring compliance. Coordinator will identify, collaborate and develop community partners to facilitate long term sustainability plans. They will manage the budget and work with the evaluator to ensure timely data submissions. They will coordinate training for site staff, provide curriculum review and coordination. Cost: $33, P age

25 1).25 Administrative Assistant: figured at a salary of $48,325.00($23.23/hr) for 1.0 FTE becomes $12, for.25 FTE. This position will assist the site coordinators and the director in scheduling training, hiring, data collection and any other support that is needed to ensure program quality. Benefits/Payroll Taxes Benefits and Payroll Taxes for all grant staff. $56,286 $ Amt: $56,286 $ Amt: Supplies/Materials $ Amt: $8,600 Program supplies for each site including consumables, curriculum, art, science, math, recreational and other activity supplies not supplied by building or partners. Administration supplies will include items that are needed to ensure site compliance such as binders, YPQI support, copies for training, office supplies as well as other items to conduct successful operations. Some specific estimated examples are below. Evergreen Elementary: $7,000 $ Amt: $7,000 Our Community Credit Union will make available $ in funding to support classroom supplies and materials. They will also provide $ in positive behavior incentive prizes to encourage participation in programs and 25 P age

26 Supplies/Materials for: Robotics $ Art $ Culinary Arts Clubs $ Drama $ Claymations/digital storytelling $ Pencils/Pens/Markers/Colors $ Room Supplies $ Glues/Paints/Brushes $ = $ Total 3, Olympic Middle School: Supplies/Materials for: Robotics $ SeaPerch $ Culinary Arts Clubs $ Drama $ Claymations/digital storytelling $ Prevention activities $500.00, + Instructor Room Supplies $200.00, Glues/Paints/Brushes $ = $ Total 3, Program Administration Office: Supplies/Materials for: Office (general) $ Printing/Copying $ Training manuals $ Miscellaneous needed for program implementation $ = $ Total 1, Total Supplies/Materials Cost: $ 7, academic growth. ESD 113 Student Assistance Program will provide supplies and materials for 2 sessions of Strengthening Families trainings. $ P age

27 Instructional Resources Instructional Resources will include items that are determined as needed based on local needs of each program. Programs have identified Lego Robotics and 3D printing as a program they will be implementing in year one of this program. These Instructional Resources will be STEM focused and linked to the school day programming. Two sites have LEGO robotics currently and will update those to the EV3 in order to be able to have the most up to date robotics educational curriculum. LEGO Robotics and EV3 update: $ D printing: $ SuccessMaker licenses ($100/each): $ Each site will have 2, for instructional resources. Total: $ * 2 sites = $ $7,000 $ Amt: $4,180 A contract with Pacific Education Institute will provide after school and summer outdoor FieldSTEM experiences. Outdoor fieldwork, journaling and world learning opportunities will be provided.$ We will also work with sites to identify other training contracts needed based on site specific needs as well as student voice to create engaging programs.$ Total: $4, $11,180 $ Amt: $15,350 Olympic College will provide instructional resources for parents and students in the form of ESL classes, field trip and computer based programs. $ Travel Travel for staff to attend training and site coordinator meetings, perform site $2,500 $ Amt: $2,500 $ Amt: 27 P age

28 supervision and staff evaluation as well as travel to purchase supplies. Site staff will also attend the OSPI summer institute or other local offerings as identified. Each site will have and administration will have Cost ($0.54/mile driving) + airfare to conferences + lodging for conferences:$2, $ Amt: $49,025 Transportation $ Amt: $0 Shelton School District is committed to providing busing for program participants to ensure they are able to attend. $ Amt: $4,000 $ Amt: $5,000 Staff Development Staff development will be identified through site needs as well as through the YPQI and annual evaluation process. Some training will be provided through $4,000 ESD 113 True North will provide Youth Mental Health First Aid Training and Networks for Life Training as well as Strengthening 28 P age

29 partnerships. Some examples are Fulcrum Student Engagement, Weather Balloon launch or 3-D printing. The other professional development will be contracted. Average training cost at $500- $1000 allows for 4-8 paid professional development opportunities in addition to those provided through Box sets and partner contribution. Families facilitator training. Staff may attend additional trainings through other ESD113 programs as relevant to the needs of the E2O sites. $ Amt: $23,000 Evaluation Independent evaluation contract to The Center for Research and Data Analysis, Dr. Todd Johnson to provide evaluation services and technical assistance to effectively measure the outcomes set forth in the proposal. 310 hours x per hour = $19,939 EZ REPORTS for per site for 2 $23,000 $ Amt: 29 P age

30 sites= $ Travel for YPQA and directors meetings= $ Travel for site observations ($0.54/mile) = $ Total Evaluation: 23, Conferences Registration fees as needed to attend the conferences as identified or required to enhance grant outcomes, compliance or performance. This total will be used amongst all sites using a process that will ensure the most efficient use of conference time. Staff that attend conferences will present at all staff meetings what they learned while attending the conference. Whenever possible, applications for scholarships to cover conference fees will be used. $1,500 $ Amt: $1,500 $ Amt: Facilities $ Amt: $ Amt: $10,000 Office space fees including all utilities, IT and maintenance. $1,987 $1,987 Shelton School District will 30 P age

31 per month for 12 months. provide all space for both sites as well as office space for the site coordinators. This is approximately dollars per site per year. Total: 10, YPQA Box Set of Materials Per Site (A minimum amount of $2200) $ Amt: YPQA Box sets and materials for both sites. 2 x 2500 = 5000 $5,000 $ Amt: $5,000 Indirect $ Amt: $ Amt: Indirect Rates (district) $24,994 $24,994 Indirect Rates (non-district) Totals: $321,458 $31,180 $352,638 $118,625 Page 4 Subrecipient Risk Assessment Questionnaire 31 P age

32 The Office of Superintendent of Public Instruction (OSPI) will use this questionnaire to assess the subrecipient s risk in consideration for issuance of a competitive subaward. Subrecipient Name: Capital Region ESD 113 Date of Incorporation: (only non-profits/for-profits): Preparer Name/Position: N/A Keley Brewster - Director of Internal Business Services Date Prepared: 07/20/2017 Section A - Administrative 1 Is the subrecipient or any principals thereof suspended or debarred from receiving federal grants/contracts ( No If yes, the subrecipient is not eligible to receive this subaward. 2 Does the subrecipient have experience administering federal awards within the past two years? Yes If yes, please specify the program name, CFDA#, and amount of federal expenditures (or attach a Schedule of Expenditures of Federal Awards at bottom of page): SEFA see attached. 3 Within the past year, has there been turnover in key position(s) who will be responsible for administering the award? No If yes, please explain: 32 P age

33 4 Has the subrecipient ever had a government contract/project/agreement terminated? No If yes, please explain: 5 Has the subrecipient had any known or suspected fraud or conflicts of interest potentially affecting federal awards? No If yes, please explain: Section B - Prior Audits and Monitoring 6 In the most recent financial statement audit, did the subrecipient: No Receive an adverse opinion or a disclaimer of opinion? Have any significant deficiencies or material weaknesses in internal control over financial reporting? If yes, please attach audit report at bottom of page. 7 In the most recent audit of federal programs, were there any findings? No If yes, please attach audit report at bottom of page. 8 Has the subrecipient received monitoring by awarding agencies within the past two years? Yes If there were any issues noted in the monitoring reviews, please attach the report(s) at bottom of page. Section C - Financial 9 Has the subrecipient had any financial condition concerns within the past two years? No 33 P age

34 If yes, please explain: 10 Does the subrecipient have any delinquent federal debt ( No If yes, please explain: 11 Does the subrecipient have a federal negotiated indirect cost rate? Yes If yes, please list the rate: 8 If no, please list the rate that will be applied to this subaward: Section D - Internal Controls 12 Does the subrecipient s financial management system: Yes Identify all federal awards received and expended, including specific information pertaining to the award: federal program name; CFDA title and number; identification number and year; and name of federal and any pass-through agency? Provide for accurate, current, and complete disclosure of the results of federal awards in accordance with reporting requirements? Include records and supporting documentation that identify the source and application of funds for federally funded activities, including authorizations, obligations, unobligated balances, expenditures, assets, income and interest? Enable the subrecipient to maintain effective internal controls to ensure accountability and proper safeguarding and use of all funds, property and other assets (for example, adequate segregation of duties)? 34 P age

35 Provide a comparison of expenditures with budget amounts for each federal award? If no, please explain: 13 Does the subrecipient have a policy and procedures to ensure compliance with federal procurement requirements? Yes If no, please explain: 14 Does the subrecipient have internal controls in place to ensure personnel expenses charged to a federal award are accurate, allowable, and properly allocated? Yes If no, please explain: Required Signatures: 21st CCLC Program Director: Finance Director for the District or Organization: Superintendent or CEO/ Designee of Organization: Erin Riffe Keley Brewster Mike Hickman for Dana Anderson UPLOAD COMPLETED FILE(s) ON OR BEFORE DUE DATE Uploaded Uploaded Files By Uploaded At 35 P age

36 SEFA ESD 113.pdf ERIN RIFFE 7/20/2017 9:38 AM ESD113 E2O Subrecipient Risk Assessment Questionnaire.pdf Christina Steele 7/21/ :55 AM Page 5 Attachments Upload the following seven completed files on or before July 24, 2017, at 4:00 PM. Assurances for Eligible Entity Partnership and compliance with Program Regulations form; printed, signed and uploaded as an attachment (Pg. 1 of igrants). Program Abstract (1 page) Program Narrative (25 pages maximum) (Amendment 28 pages maximum) Director, Site Coordinator, and Direct Services Staff Job Descriptions 36 P age

37 A 21st CCLC Program/Project Organizational Chart (1 page) Current Data Sharing Agreement signed by all parties that satisfies data use and sharing requirements outlined in assurances. Memorandum of Agreements (MOUs) between all major partners and fiscal agent signed by all authorized representatives File names may not include symbols, including #. Uploaded Files Uploaded By Uploaded At ESD113 E2O Assurances.pdf ESD113 E2O Data Sharing Agreement.pdf ESD113 E2O MOU.pdf ESD113 E2O Org Chart.pdf ESD113 E2O Pathways Job Descriptions.pdf ESD113 E2O Program Abstract.pdf ESD113 E2O Program Narrative.pdf ERIN RIFFE ERIN RIFFE ERIN RIFFE ERIN RIFFE ERIN RIFFE Christina Steele Christina Steele 7/20/2017 5:10 PM 7/20/2017 5:10 PM 7/20/2017 5:10 PM 7/20/2017 5:10 PM 7/20/2017 5:10 PM 7/21/ :52 AM 7/21/ :20 AM 37 P age

38 38 P age