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: Boys and Girls Clubs of Whatcom County 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 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 1 P age

2 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: Name of Organization or School District: Heather Powell Chief Executive Officer Boys & Girls Clubs of Whatcom County Signature: Telephone Number: ext Name of Primary Partner Representative: (District Superintendent or Chief Executive Officer) Title of Authorizing Primary Partner Representative: hpowell@whatcomclubs.org Charles Burleigh Superintendent 2 P age

3 Name of Organization or School District: Mount Baker School District Signature: Telephone Number: (360) Date (MM/DD/YY): 7/17/2017 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 P age

4 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. 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. 4 P age

5 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: 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. 5 P age

6 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 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. 6 P age

7 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. 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. 7 P age

8 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. 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 8 P age

9 Program Profile Grantee Name: Boys & Girls Clubs of Whatcom County Grant Request Amount: $358,677 What school districts will be served by this project? Mount Baker School District If you were a previously funded project, what year was the grant awarded? 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. 9 P age

10 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.). 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 through 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 10 P age

11 Site Name? Kendall Elementary School School Based? Yes Community Based Center? Yes Address where services are provided: 7547 Kendall Rd, Maple Falls, WA Name of School Building(s) served: Kendall Elementary School Building Address: 7547 Kendall Rd, Maple Falls, WA School District Address: 4956 Deming Rd, Deming, WA Building Code(s): 106 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-6th No Yes 74% 11 P age

12 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) 66% 75% 70% 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? Mount Baker Junior High School School Based? Yes Community Based Center? Yes Address where services are provided: 4936 Deming Rd., Deming, WA Name of School Building(s) served: Mount Baker Junior High School 12 P age

13 Building Address: 4936 Deming Rd., Deming, WA School District Address: 4956 Deming Rd, Deming, WA Building Code(s): 323 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) th- 8th No No 60% 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) 37% 48% 43% 13 P age

14 Adult Services 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 1-Y 1-N 68% 24% 52% 62% 57% Summer Program 14 P age

15 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? June through August 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? Kendall Elementary School School Based? Yes Community Based Center? Yes Address where services are provided: 7547 Kendall Rd, Maple Falls, WA Name of School Building(s) Served: Kendall Elementary School Building Address: 7547 Kendall Rd, Maple Falls, WA School District Address: 4956 Deming Rd, Deming, WA Building Code: 106 Student Services Summer 15 P age

16 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-6th Site Profile Site Name? Mount Baker Junior High School Based? Yes Community Based Center? Yes Address where services are provided: 4936 Deming Rd., Deming, WA Name of School Building(s) Served: Mount Baker Junior High School Building Address: 4936 Deming Rd., Deming, WA School District Address: 4956 Deming Rd, Deming, WA Building Code: 323 Student Services Summer 16 P age

17 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 th-8th 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. Site Name: Kendall Elementary School 17 P age

18 Literacy Subject Curriculum (if known) Academic Remediation, istride Academy, Power Hour, Project Learn, Summer Brain Gain Science Power Hour,STEM Programming, Project Learn, Summer Brain Gain Math Academic Remediation, Power Hour, Project Learn, Summer Brain Gain Art & Music The Arts, Summer Brain Gain Cultural & Social Studies Youth Development Positive Action, Community Service Clubs, Tribes Learning Community, SMART Moves, SMART Girls Telecommunications & Technology Health & Nutrition STEM Family Engagement STEM programming Meal Program, Triple Play, Summer Brain Gain Power Hour, STEM Programming, Summer Brain Gain, Parent Orientation, Monthly Family Nights, Annual Resource Fair 18 P age

19 Family Education Literacy, Financial Literacy, Building Healthy Communities, Non-violent Conflict Resolution ELL Curriculum Career and Technical Ed Academic Remediation, Power Hour Tribes Learning Community Site Name: Mount Baker Junior High Literacy Subject Curriculum (if known) Academic Remediation, Power Hour, Project Learn, Summer Brain Gain Science Power Hour, STEM Programming, Project Learn, Summer Brain Gain Math Academic Remediation, Power Hour, Project Learn, Summer Brain Gain Art & Music The Arts, Summer Brain Gain Cultural & Social Studies Youth Development Positive Action, Community Service Clubs, Tribes Learning Community, SMART Moves, Street SMART, One Circle 19 P age

20 Foundation, Torch Club, Telecommunications & Technology Health & Nutrition STEM Family Engagement STEM programming Meal Program, Triple Play, Summer Brain Gain Power Hour, STEM Programming, Summer Brain Gain, Parent Orientation, Monthly Family Nights, Annual Resource Fair Family Education Literacy, Financial Literacy, Building Healthy Communities, Non-violent Conflict Resolution ELL Curriculum Career and Technical Ed Academic Remediation, Power Hour Tribes Learning Community, Money Matters, Career Launch, Leader in Training (LIT) Page 3 20 P age

21 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 (1)- Program Director- $50,000/ yr (2, 1 per site)- Site Coordinators- $25.00/ hr x 29 hrs/ wk x 45 wks= $65,250 (7, elementary, Jr. high) Academic Enrichment Leaders $30/ hr x 6 hrs/ wk x 35 weeks = $44,100 (6) Summer Enrichment Leaders- 3 hrs/ day x $30/ hr x 25 days = $13,300 (6-4 elementary, 2 Jr. high) Youth Development Professionals- $16/ hr x 20 hr/ wk x 40 wks= $76,800 Finance & Administration- $7,800 Grants Specialist- $3,848 Operations & Administration- $274,948 $ Amt: $274,948 $ Amt: $38,684 BGCWC- $25,148 Mt. Baker Schools- $13, P age

22 $13,500 Benefits/Payroll Taxes Health, Dental, Life, Short/ Long Term Disability Insurance = $4,500 Payroll Taxes = $20,135 $24,635 $ Amt: $24,635 $ Amt: $2,000 BGCWC Supplies/Materials (3)Rolling Storage carts- $927= $2781 (3) Staff Computers- $800= $2,400 Consumable Supplies (paper, pencils, markers, glue, craft supplies,) $500 Makey Makey STEM kits- 15 x $99 = $1,485 School year meals 90 kids x 160 days x $3.66/ day= $52,704 Summer meals- 90 kids x 25 days x $3.80= $11,400 Summer Snacks- 90 kids x 25 days x.91= $2,730 $74,000 $ Amt: $74,000 $ Amt: $66,834 OSPI meal program Instructional Resources TRIBES Curriculum 2 sites x $90 = $180 Stride Academy Online Learning annual license $6,000 Positive Action Curriculum Grade $17,425 $ Amt: $17,425 $ Amt: 22 P age

23 8 kit, Grade 6 kit, Grade 4 kit & Grade 2 kit= $1650 Flag House Catch Resources- Grades K-5 = $1,709, Gradde 5-8- $4,686 One Circle Curriculum, 1 each boys & girls sets $3,200 Travel.52/ mile x 200 miles/ week x 45 weeks= $4,865 $4,865 $ Amt: $4,865 $ Amt: Transportation School year $28.53/ hour x 2 drives x 1 hour = $56.71/ day x 220 days = $12,476 School year mileage- 2.48/ mile x 70 miles/ day= $176.16/ day x 220 days= $38,315 Summer- 2.48/ mile x 140 miles = 336/ day x 25 days = $8,800 $28.53/ hour x 2 drivers x 4.5 hours day x 25 days = $6,419 $53,534 $ Amt: $53,534 $ Amt: $38,315 Mt. Baker School District Staff Development Spillett University- $500 Youth Voice $40 pp x 6 people = $ mileage = $385 Planning & Reflection- $40 pp x 6 people = $ mileage = $385 $3,038 $ Amt: $3,038 $ Amt: $500 BGCWC- Access to Spillett University 23 P age

24 Building Community- $40/ pp x 6 people = $240 + $145 mileage = $385 Risk Management= $59/ pp x 6 people = $ mileage = $499 Reframing Conflict- 40/ pp x 6 people = $ mileage = $385 Participatory Approach- $59 pp x 6 people = $354 + $145 mileage = $499 Evaluation Site 1- $10,000 Site 2- $10,000 Project management: -3 surveys developed, administered, analyzed, reported (pre- post-) -YPQI training -Site visits(s) -Provide, clean, analyze data -Reports (mid- and annual reporting) -Consult $20,000 $ Amt: $20,000 BERC Group $40,000 $ Amt: Conferences Bridge Conference $425 pp x 8 people= $3,400 + $1,200 hotel, + $320 food + $145 mileage = $5,065 CLC Summer Institute- hotel $8,165 $ Amt: $8,165 $ Amt: 24 P age

25 estimate for 8 people $2,800 + mileage estimate $300= $3,100 Facilities Site 1- $27.86/ hour x 440 hours= $12,258 Site 2 $27.86/ hour x 300 hours = $8,358 $20,616 $ Amt: $20,616 $ Amt: $20,616 Mt. Baker School District YPQA Box Set of Materials Per Site (A minimum amount of $2200) Site 1= $2,200 Site 2= $2,200 $4,400 $ Amt: $4,400 $ Amt: Indirect Indirect Rates (district) $ Amt: $0 $ Amt: Indirect Rates (non-district) Totals: $505,626 $20,000 $525,626 $166,949 Page 4 Subrecipient Risk Assessment Questionnaire 25 P age

26 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: Date of Incorporation: (only non-profits/for-profits): Preparer Name/Position: Boys & Girls Clubs of Whatcom County April 16, 2012 Heather Powell / CEO Date Prepared: 7/20/17 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): Department Of Justice Mentoring Opportunities for Youth Initiative (CFDA #16.726)- $30,000. This money comes to Boys & Girls Clubs of Whatcom County through Boys & Girls Clubs of America. 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: 26 P age

27 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? No 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 27 P age

28 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? No If yes, please list the rate: 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)? 28 P age

29 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: Kim Grams Melinda Stump Heather Powell UPLOAD COMPLETED FILE(s) ON OR BEFORE DUE DATE Uploaded Files Uploaded By Uploaded At 29 P age

30 Files have not been uploaded 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 Program Abstract (1 page) Program Narrative (25 pages maximum) (Amendment 28 pages maximum) Director, Site Coordinator, and Direct Services Staff Job Descriptions A 21st CCLC Program/Project Organizational Chart (1 page) 30 P age

31 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 21st CCLC Program Organizational Chart.pdf Data Sharing Agreement.pdf Determination of Eligible Entity Partnership.pdf Job Descriptions.pdf Memorandum of Agreement.pdf Program Abstract.pdf Program Narrative.pdf Uploaded By Allison Hegan Allison Hegan Allison Hegan Allison Hegan Allison Hegan Allison Hegan Allison Hegan Uploaded At 7/21/2017 1:50 PM 7/21/2017 2:14 PM 7/21/ :24 AM 7/21/2017 1:49 PM 7/21/2017 2:17 PM 7/21/2017 1:30 PM 7/21/2017 2:23 PM 31 P age