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Application for Federal Assistance SF 424 page of OMB’s webpage version Version 1. Type of Submission. Preapplication Application Changed Corrected Application 2. Type of Application If revision select appropriate letter New ~ Continuation Other Specify Revision 3. Date Received. 4. Applicant Identifier. 5a. Federal Entity Identifier 5b. Federal Award Identifier. State Use Only 6. Date Received by State. 7. State Application Identifier.
8. Applicant Information. a. Legal Name. ABC College Consortium b. Employer Taxpayer Identification Number EIN TIN 12 3456789 c. Organizational DUNS. d. Address. Street 1. NE 40th Place Street 2. City. Redmond County. King
State. Washington Province. Country. USA Zip Postal Code. e. Organizational Unit Department Name. Division Name. f. Name and contact information for matters involving this application. Prefix. Mr. First Name John Middle name. Last Name. Smith Suffix.
Title. Provost Organizational Affiliation ABC College Telephone Number. 425 555 1212 ext. Fax Number. 425 555 1213 E mail. Application for Federal Assistance SF 424 pages and of OMB’s webpage version Version 9 Type of Applicant. #1 ABC College Consortium NE 40th Place Redmond WA PH 425 555 1212 FX 425 555 1213 www.abccc.net
Project Rural Distance Learning Prepared for. U.S. Department of Agriculture Office of Distance Learning & Telemedicine Prepared by. John Smith President Description ABC College Consortium application for $499 in funds to provide demonstrate innovations in teacher training using new equipment software training and connectivity to residents in five counties. We are IRS organization requesting the additional funds for projected $948 budget for the total project. Our current organizational budget is $10 000. The reason for the grant is to accelerate teacher and faculty proficiency with integrating advanced communications and information technologies associated with improved student achievement. Proposal Number. CFDA 10.855 page left intentionally blank
Table of Contents Introduction Project Information Statement of Experience Objective Scoring Subjective Scoring Contact with USDA
Certifications Site Worksheet Fixed Sites Attachment to SF See 1 and 2 in Section IV of the Application Guide Column 1. For each Hub combined Hub End User and End User site show its complete official name and abbreviation should you choose to use one. Each site name or abbreviation must be used consistently throughout the balance of your application. Below the site name show the complete street address. The address must be one recognized by Census’ American Factfinder. If the only address available for site is PO Box Star Route Rural Route or other address not recognized by Factfinder give that address supplemented by the precise latitude and longitude DD MM SS or DD.DDDD. Column 2. For each site show how you designate the site. i.e. as Hub Hub End User or End User. Column 3. Show the County in which the site is located Column 4. Show the School District in which the site is located.
Column 5. Show the Congressional District in which the site is located example. MI 57th Dist. John Smith. 1. Complete Site Name Abbreviation if any Complete Street Address DD MM SS or DD.DDDD if needed see instructions 2. Site Designation 3. County 4. School District 5. Congressional District 1 ABC College NE 40th Street Redmond WA HUB Name NA WA 160 2 High School Name Street Address City State Zip Code End User Name Name WA 160 3 Middle School Name Street Address City State Zip Code End User Name Name WA 160 4 Elementary School #1 Street Address City State Zip Code End User Name Name WA 160 5. PreK School Street Address City State Zip Code End User Name Name WA 160 You are not restricted to sites. continuation sheet follows this page. If you have many sites use as many continuation sheets as you need. Place this sheet behind SF 424 under Tab of your Application Site Worksheet Non Fixed Sites Continuation
1. Complete Site Name Abbreviation if any Complete Street Address DD MM SS or DD.DDDD if needed see instructions 2. Site Designation 3. County 4. School District 5. Congressional District 6 Local Library Street Address City State Zip Code End User Name Name WA 161 7 Non Profit Partner Street Address City State Zip Code End User Name Name WA 161 Survey on Ensuring Equal Opportunity for Applicants Reproduction of OMB No. 1890 0014 EXP 28 Purpose. The Federal government is committed to ensuring that all qualified applicants small or large non religious or faith based have an equal opportunity to compete for Federal funding. In order for us to better understand the population of applicants for Federal funds we are asking nonprofit private organizations not including private universities to fill out this survey. Upon receipt the survey will be separated from the application. Information provided on the survey will not be considered in any way in making funding decisions and will not be included in the Federal grants database. While your help in this data collection process is greatly appreciated completion of this survey is voluntary. Instructions for Submitting the Survey. If you are applying using hard copy application please place the completed survey in an envelope labeled "Applicant Survey." Seal the envelope and include it along with your application package. If you are applying electronically please submit this survey along with your application. Applicant’s Organization Name. ABC College Consortium
Applicant’s DUNS Number. 12 3456789 Federal Program. Distance Learning & Telemedicine Grant Program CFDA Number 10.855 1. Has the applicant ever received grant or contract from 6. How many full time equivalent employees does the the Federal government. applicant have. Check only one box. For example two part time employees who each work half time equal one full time equivalent Yes No employee. If the applicant is local affiliate of national organization the responses to questions and should reflect the 2. Is the applicant faith based organization. staff and budget size of the local affiliate. Yes No Self Identify ~ 3. Is the applicant secular organization. or fewer 15 50 5 51 100 14 over Yes No Self Identify 7. What is the size of the applicant’s annual budget. Check only one box. Annual Budget means the amount of money your 4. Does the applicant have status. status organization spends each year on all such activities. is legal designation to the Internal provided on application S li ibl i less than $150 $150 $299 do not. $300 $499 Yes No $500 $999 $1 000 $4 999 5. Is the applicant local affiliate of national organization. $5 000 or more Yes No Self Explanatory Paperwork Burden Statement. According to the Paperwork Reduction Act of no persons are required to respond to collection of information unless such collection displays valid OMB control number. The valid OMB control number for this information collection is 1890 0014. The time required to complete this information collection is estimated to average five minutes 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 estimate or suggestions for improving this form please write to the Agency Contact listed in this grant application. Legal Eligibility Name of Applicant. John Smith Organization. ABC College Consortium
17410 NE 40th Place Redmond WA To Whom It May Concern. Please be advised that am the attorney for ABC College Consortium which has its principle offices located in Redmond WA. On behalf of ABC College Consortium it is my legal opinion based on my knowledge of the legal status of ABC College Consortium in Washington State that it is now and has always been legally organized as institution type here under Washington State law. As legally organized institution of higher education it has the full legal power and authority to take any and all actions allowable by Washington State law and other applicable laws and regulations including legal authority to contract with RUS in accordance with those laws and regulations. If any person or entity has any questions regarding this opinion and or the status of ABC College Consortium as described herein would be happy to address those questions. Sincerely Mary Smith Esq. General Counsel
Executive Summary C. Project Information 1. Abstract The ABC College Consortium located in Washington is composed of counties and home to 1.23 million of the state’s population. The area contains three national parks at its edges 000 acres of state and farmland bordering Oregon and the Pacific Ocean. The once thriving region has declined since its manufacturing base disappeared. Job losses and the slowing economy have sparked multiple needs in education for example high demand for college degrees in science and technology; inadequate professional development in technology integration for to teachers and college faculty; increase demand for accountability and growing gaps in academic achievement. The purpose of the project is to accelerate and sustain professional development in technology integration for PreK to college teachers resulting in improved achievement for students. The project combines distance learning face to face web enabled instruction and mobile technologies to enhance teacher ability to improve the educational outcomes for students in our region. Project Summary D. Project Information
Project Summary The main components of our project are. Create "hub" for the management coordination and maintenance of low cost Internet platform that enables the development of new elearning community able to share content assess academic performance and create remedial solutions across multiple sites; Grow the number of teachers and faculty capable with blended learning methodologies evaluations and solution fabrication; Offer equipment software and training upgrades to students teachers social service professionals librarians parents business partners and community partners; Implement sustainable solution through the use of change management toolkit and;
Improve student achievement in mathematics science and language arts for students in grades PreK to 16. 1. Overview of Telecommunications System The ABC College Consortium will connect its members through hub hosted by the College. Equipment software mentoring and training will be provided to each site. The three school districts libraries and social services agency will receive enhanced educational content applicable to PreK to students. The hub will create content based on needs generated through existing school district technology plans and community needs assessments. ABC College will also provide location for business and community organizations to access content collaborate communicate and guide authentic content for standards based curriculum. The hub will offer opportunities for teachers to conduct research and collaborate further across districts regionally statewide nationally and globally under the Blackboard Academic Suite Internet2 and Learning Guidebooks sponsored by the Commonwealth Education Media Center for Asia and the U.S. Office of Education – for free online resources. ABC College already serves as site for the Small Business Development Centers and One Stop Career Centers in Redmond. It has agreed to work with the regional Workforce Investment Board and other post secondary institutions to promote regional plans to develop talent through entrepreneurial outreach programs in 12 schools. Working with the WIRED program from the U.S. Department of Labor effort will be made to focus on the Skills Competency Certification program for high growth jobs. The hub will extend connections for the workforce development community and offer training opportunities in conjunction with the goals of the initiative. Institution with its SITES program; National Action Council for Minorities in Engineering and the National Engineers Week program to enhance live action virtual field trips and on site programs in mathematics science and language arts. Technical purchases will include. Infrastructure upgrades including wiring to insure processing speeds network compatibility and software alignments to enable distance learning at all sites; Computers to help students parents and social services professionals access enhanced supplemental programs; web based instruction and coursework; Smart boards and related technology equipment to enable upgrades in multimedia content and provide on site training of teachers and applied professionals; 2. Site Description