USDA Federal Government Grant Proposal
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
The ABC College Consortium includes one hub and fourteen end user sites. 3. How the project will address community needs why we require financial assistance and how the project benefits rural residents. We propose to respond to community needs document funding requests and detail project benefits to rural residents through program management plan. Planning teams at the college school districts libraries and social service agencies conducted thorough needs assessments gathered and analyzed the results relative to student achievement demographics and staff development. Group technology plans reviewed existing instructional programs and materials and profiled community needs. Based on this process our collaborative plans to field Virtual Team for the project trained together reflect their individual constituencies but collaborate on decisions evaluate outcomes and communicate results regionally. Tab 1 System Plan D – Telecommunication System Plan & Scope of Work 1. Explanation of types of distance learning proposed statement that the project is for distance learning and explanation of how the project meets the regulatory definition of distance learning. ABC College Consortium is distance learning project. It is collaboration between ABC College Redmond Public Schools Seattle Public Schools Public Library Social Services Agency and Bellevue Charter School. It connects students teachers parents other professionals businesses and community social service agency across rural areas using both telecommunications and information technologies. The project uses curriculum defined and measured by state standards aimed at improvements in language arts mathematics science and technology for students in college three school districts and nonprofit grades PreK to and registered users of the County library. It applies new tools to elementary secondary and postsecondary courses aimed at advancing student achieve through blended learning methodologies tied to on going professional development for teachers and allied professionals serving our region. The Consortium uses standard distance learning strategies and applies best practices from successful national programs to support blended learning implementation. The standard distance learning categories include. adaptation of classroom content at one site and transmittal to other remote sites capture of online coursework and extension of online forums seminars and online catalogs for use by teachers and staff. The Centenary hub will provide partners with access to courses that are not typically available to our school sites. These courses include. advanced science mathematics and technology preengineering courses and additional foreign languages. Students will also be able to attend live action programs virtual field trips beyond their rural environment and connect them to global elementary secondary and tertiary education. In addition the program seeks to cultivate local business and professional organizations to further enhance and authenticate the current course content provided in the target curriculum. Our innovation for the project comes in two forms. planning and executing Change Management Toolkit for educators business allied professionals and community leaders working to upgrade the curriculum and distance learning in our schools and effort to network for virtual schools at both the high school and elementary levels over the next three years. We use distance learning systems to provide connectivity for our change management team provide Virtual High School and elementary programming.
The change teams would involve student teacher and local mentors working together to improve performance. The virtual high school programs would also participate in yearly forums onsite at the college and host representative teams demonstrating the results of their work for example website design and new ways of managing class assignments college preparation techniques and small business ideas that are developed by students. Video from all sites would be developed using the distance learning equipment and would include team building activities; meetings; school programs and other activities that students not present could view at home school laboratories Social Service Agency and Seattle Public Housing Authority sites. Ultimately the expansion of virtual programming leads to interactions among students from our communities across the state and internationally. Schematics D1 Map with Network Diagram Statement of Work Scope of Work 1. Program Activities to be carried out Tab 2 Overall Budget Worksheet See 1 and 2 in Section IV of the Application Guide
Line Item No. Site Name Description Unit Cost No. Extended Cost DLT of Use 1. ABC College Software & ASP Services $57 $57 700.00 2. ABC College Hosting Services for Academic Suite $125 $125 000.00 3. ABC College Learning System $89 $89 000.00 4. ABC College ASP Hosting $70 $70 000.00 5. ABC College Customer Programming $125 $375 000.00 6. ABC College Infrastructure. wiring cables connections equipment $98 $98 000.00 7. High School. Smart Classroom. equipment $15 $15 000.00 8. High School VHS Virtual High School Seats $340 $17 000.00 9. High School. VHS Teacher Training $3 $3 500.00
10. Middle School Software $1 $28 750.00 11. Middle School Direct Response Support $1 800.00 12. Middle School Smart Classroom. equipment $14 491.30 $14 491.30 13. Elementary 1. Full Curriculum Software $1 $6 900.00 14. Elementary Direct Response Support $600.00 15. Elementary On Site Training $1 day $6800.00 16. Elementary Student Resource Materials $720 $720.00 17. Elementary Smart Classroom. equipment $15 $15 000.00 18. Elementary 4. On Site Training $1 day $6 800.00 19. Elementary 4. Student Resource Materials $720.00
20. Elementary 5. Early Reading Software $3 $12 000.00 21. Elementary Full Curriculum Software $1 $6 900.00 22. Elementary 6. Direct Response Support $600 $600.00 23. PreK Social Service. Smart Classroom. equipment $15 $15 000.00 24. Library Smart Classroom. equipment $15 449.84 $15 449.84 25. Housing Authority Smart Classroom. equipment $15 449.84 $15 449.84 $998 180.98 Overall Project Budget – Page Subtotal
Budget Summary A. Sum of page and continuation sheets subtotals Overall DLT Project Budget4 $1 813.28 B. as documented under Tab 3 Less Proposed Cash Match5 $566 480.00 C. from In Kind Match Worksheet Less Proposed In Kind Match5 $171 990.00 D. from Other Funds Worksheet Less Other Funds E. DLT Grant Request – – – $499 999.00 Place this Worksheet under Tab 2 of your Application
In Kind Match Worksheet See 1 2 & 3 in Section IV of the Application Guide Proposed Matching Funds are generally cash. If any of the line items shown on the Overall Budget Worksheet are specified in the match documentation they are in kind. Show them below in the same manner line item site name description as on the Overall Budget Worksheet. If only portion is attributable to the DLT project show that portion here and the balance that is not eligible on the Other Funds Worksheet. In the right column clearly identify the source. Remember to document proposed matching funds under Tab 3 otherwise they will not be credited as an eligible match. Other Funds Worksheet See 1&D in Section IV of the Application Guide Some line items included in DLT Project Budget are not eligible as either grant or match. The funds for these must come from other sources and are designated "Other Funds." Some line items are only partially eligible as grant or match. The balance of these must also come from other sources. Show all other funds below in the same manner line item site name and description as on the Overall Budget Worksheet. Show the ineligible line item cost or portion thereof in the "other fund cost" column adjacent to the source of that funding.
Tab 3 Financial Information D – Financial Information and Sustainability 1. Description of the project’s revenues and expenses The ABC College Consortium is not revenue producing project instead it seeks to motivate improvements in mathematics science and language arts by engaging participants in innovative communications and information technology tools. Participants will experience cost savings via. Access to high quality educational content at low or no costs; Ability to participate in professional development without the expense of travel paying for substitutes and the costly experience inviting experts to rural areas; Using virtual field trips; live action experience through partners such as the Smithsonian Institution and online courses available also provide new opportunities for both students and teachers to explore communicate create assess and evaluate without today’s travel expenses; Collaboration among teachers and allied professionals should reduce fees for professional services as teams realize savings by sharing content resources and ideas and; finally;
Students can experience an increase in productivity when exploring new careers and opportunities by working through the new eLearning community under development. These new networks both human and digital will provide excellent alternatives to current means for career exploration. Direct expenses are tied to maintenance fees of both equipment and software and we anticipate those costs to be about $35 per year. 2. Evidence of cost sharing arrangements among hub and end user sites if applicable. All sites will share costs by collaboration and consolidation of expenses in number of areas for example. Expenses Cost Sharing Opportunities Systems support ABC College Consortium working through ABC College hub end user site provides enhanced expertise for members. Using the Blackboard Academic Suite enables dramatic change in systems integration maintenance and community opportunity to work remotely reduce costs of on site meetings and "personalize" training so that common framework enables members to learn together and eliminate non alignment in tools.
Sustainability Insuring Sustainability We designed this system for long term reliability and efficiency. Equipment was selected that works with both ISDN and IP connections. Additionally ABC College has been named by Intel as one of the top colleges in the nation for wireless. Our Office of Technology is working with ITunesU Apple Intel IBM and others to test and evaluate new approaches using new technologies. This opportunity can be shared with our – partners as well. We are planning on Rate funding to help streamline costs for maintenance of connections. Also the College seeks to share one hundred computers turned in and repaired into sign outs for parents and small businesses seeking to upgrade their skills or tune into the world of their children. 3. Demonstration how benefits including costs savings of the DLT grant pass through to those receiving the services from the project. The project was designed to meet specific needs of the communities served. Tab 4 Capabilities D – Statement of Experience ABC College has distinguished history with innovation. It has been named one of the top wireless colleges in the nation by Intel is the fastest growing college in New Jersey with enrollments expanding by 100% in years. It is top pick for college bound high school students and non traditional working adults. The Centenary staff has experience with distance learning and has worked with students and community to demonstrate innovations in education. The project will be led by. Carlos Jones
Carlos Jones began his career in the United States Army from the years 1976 1996. While there he attained the rank of Sergeant First Class Airborne Infantry. From there he began work with Kinney Systems Inc. in New York City in as Business Manager NT Systems Support Specialists. He provided PC support end user training database administration and VPN security at company headquarters. He also developed database to track financial performance of individual parking facilities and the entire company. In he worked as the Manager of Information Technology for Intel in Tempe AZ. He managed multi platform and telecommunications network for the leading provider of business consumer and targeted research and analysis company supporting users at locations. He supervised programmers and network technicians reviewed their daily progress in 7 environment and evaluated networking and programming projects. He also oversaw systems setup daily backup connectivity virus inoculation performance tuning optimization troubleshooting and repairs. He also rebuilt the data infrastructure from inception through operation linked three offices with and Frame Relay technology and implemented ADP payroll system with Citrix Metraframe. He went to work for LaneLabs USA Inc. in Allendale New Jersey also as Manager of Information Technology in 2000. While there he managed the database and telecommunications network for the pharmaceutical company supporting sixty users. He rolled out the new Great Plains Dynamic accounting and new CRM Catalog package. He rebuilt the telecommunications package including disaster recovery for mission critical toll free numbers. He also rebuilt the data infrastructure and the call center. Since Jones has been employed by ABC College as the Chief Technology Officer. He guided the College in its implementation of the new Student Information System educational CRM and Blackboard software packages. He is responsible for all technology in one of the fastest growing independent colleges in Washington. The institution has rated in the Top colleges in the United States with 100% wireless network on all four of its campuses. He also rolled out Active Directory and upgraded infrastructure to current technology. He built the wireless infrastructure implemented VoIP VPN Cisco Clean Access and Mirage inverted firewall. He also redesigned and upgraded Core Switching Cisco to 6513. Qualifications
His technical competencies are vast including. UNIX Linux Windows and Mac OS operating systems VB.net C++; and Java programming languages Oracle SQL Server DB2 and MySQL databases; large array of web technology; development tools including Sublime Visual Source Safe WinRunner Visio MS Project and FastTrack; hardware such as Cisco Networking Mirage Packetteer IP Telephony and wireless technologies; and he is proficient in numerous network system management products like Tivoli TME CA UniCenter Track It BMC Patrol Legato and Veritas products. His objective has been and continues to be to lead an organization in the development of cutting edge solutions that enhance the way technology is used. He also strives to apply his experience in information technology software product development and engineering to improve his organization’s products services methods of communication and problem solving strategies. Hughes holds Masters of Business Administration degree from New York University and Bachelors of Science degree in Accounting from Rutgers University. Dr. John Smith Is the Provost and Chief Operating Officer at ABC College. In addition to his background in building successful education programs in business he also an expert in medieval and renaissance literature Shakespeare Chaucer literary criticism linguistics and stylistics writing tutoring and composition. Dr. Smith holds B.S. in Mathematics from Moravian College an M.A. in English Literature from Wake Forest University and Ph.D in Electrical Engineering from Rutgers University in New Jersey.
An original work published by Dr. Smith includes Pestilence in Medieval and Early Modern English Literature published by Routledge. In addition he published number of articles which have appeared in The OWL Construction and Maintenance Guide Connecticut Review Modern Language Association The Writing Lab Newsletter and Essays in Medieval Studies 13. Dr. Smith is Redmond resident and is an active member of the community. He has been County Chamber of Commerce festival committee member since and currently serves on the board of directors. He is also the public director of the United Methodist Church. Superintendent of Schools Dr. Robert Gray is the Superintendent of Schools and supervises of the fourteen schools in our network. He is known as state leader in virtual programming and is focused on upgrading the credentials of teachers and related professional staff in using Smart Classrooms to facilitate learning at school home or in the community. Dr. Gray is graduate of Claremont College in CA; earned his master’s degree from Columbia University in the School of Education focusing on computer instruction and earned his doctorate at the University of California. His district has been singled out by the NSF for inclusion in an upcoming grant to advance mathematics science and computer science skills of students’ grades through in the region. He is in joint collaborative with local independent college county college and county vocational technical schools.
Mrs. Janice Trinkle Janice Trinkle is the Associate Director for Social Services covering the five counties in the grant application. She directly supervises programs for 000 low income families in the region. Her credentials include. B. A. from Hunter College NY Master’s Degree in Social Work from Rutgers University. The target of interest for the Social Services agency are PreK Students from local housing authorities whose families earn less than $12 per year. The students identified will be taken through at home instruction with computers donated by local colleges and software from the school district as well as in class. The agency has extended the school services to full day of educational and recreational programming for these students. Parents will be involved through Podcasts for Parents programs which is funded by other grant monies State Department of Education where they will receive equipment and software to run the programming offered by the Consortium. This programming not only keeps parents abreast with PreK training but offers them window to GED and post secondary programming also available through the Consortium. Tab 1 Rurality Worksheet – Fixed Sites
For more complete guidance in completing this sheet see 1 in Section IV of the Application Guide Categorization Population Points Exceptionally Rural – Any area of the US NOT included within the boundary of or fewer Census Urbanized Area or Urban Cluster having population in excess of 000. This includes Urban Clusters between and as well as Census Rural Areas. Rural – Any area of the US included within the boundary of Census Urban Cluster having population over 000 and not in excess of 000. 10 Mid Rural Any area of the United States included within the boundary of Census Urban Cluster over 000 and not in excess of 000. 001 20 Urban Area Any area of the United States included within the boundary of any Urbanized Area or Urban Cluster in excess of 000. 001 or more Enter each hub hub end user and end user site in the table below. Provide data for hubs. Place pure hubs at the beginning of the list separated by space and do not include them in your estimated Rurality score. Use the table above to determine points for each site. To document the numbers attach Census Fact Finder Urban Area map printouts and data sheets for each site showing precisely where the site is in relation to the urban areas shown on the map. Any end user site without verifiable census documentation will be evaluated as urban zero points. Remember that your sites must be consistent throughout the application including on the Rurality and NSLP Worksheets the Site Worksheet the Executive Summary the Telecommunications System Plan and the Budget. If the end user sites are not consistent your application is unscorable and will be returned as ineligible.
Applicant’s Estimated Rurality Score Sum of Rurality Points # of End User Sites Rurality Worksheet – Non Fixed Sites Site Name Location RuralitySite Type Census Census Same numbering and order as Site & NSLP Worksheets. Hub etc. PointsDesignation Population
Number consecutively from previous sheet Elementary End User Mid Rural 666 15Seattle WA Elementary End User Mid Rural 666 7 Seattle WA Elementary End User Mid Rural 666 8 Bellevue WA Elementary End User Mid Rural 166 9 Bellevue WA Elementary End User Mid Rural 166 10 Redmond WA Library End User Mid Rural 166
11 Seattle WA Housing Authority End User Mid Rural 166 12 Seattle WA PreK Charter School End User Mid Rural 166 13 Redmond WA Middle School End User Mid Rural 166 14 Redmond WA Middle School End User Mid Rural 166 15 Redmond WA Place Rurality Worksheets and Census Documentation under Tab 1 of your Application Tab 2 NSLP Worksheet – Fixed Sites
For more complete guidance in completing this sheet see 2 in Section IV of the Application Guide Decision Table Is site Eligible for NSLP. Use NSLP for Specific School Use NSLP for School District where site located Type of End User A Public School 12 Yes Yes No A Private School 12 No No Yes College Other Educ. No No Yes All Others Hospital Public Library Clinic etc. A No Yes
Point Eligibility NSLP 25% Zero 25%~NSLP 50% 50%~NSLP 75% NSLP 75% Enter each site in the table below placing them in the same order as on the Site Worksheet and Rurality Worksheet.
Identify the site by type. Provide data for hubs. Place pure hubs at the beginning of the list separated by space and do not include them in your estimated NSLP score. The Decision Table above shows whether to enter specific school or district information for each site. Remember that your sites must be consistent throughout the application. If the end user sites are not consistent your application is unscorable and will be returned as ineligible. The Agency will not research and confirm undocumented data. Applicants must provide documentation for each site’s percentage with written certification from the organization that administers the NSLP in your area that the data are accurate and the most recent available. Some official NSLP data is posted on state websites. If so you may provide printouts from these sites and enter the URL. Data from unofficial websites is not acceptable. Place all NSLP certifications and any other documentation behind this Worksheet. Any site without verifiable documentation will be evaluated at zero percent eligibility. Site Name Same numbering and order as Site & Rurality Worksheets Site Type Hub etc. Total Students Eligible Source of Attached Certified Data or URL if applicable 1 ABC College Hub End User NA www.abccc.net 2 High School End User 6.40 www.abccc.net 3 Middle School End User 21.5 www.abccc.net 4 Elementary School End User 29.65 www.abccc.net 5 PreK Charter School End User 18.93 www.abccc.net Average NSLP Sum of NSLP Percentages # of Sites & then rounded to an Integer 25% Applicant’s Estimated NSLP Score Enter Points from Scoring
Table NSLP Worksheet – Non Fixed Sites Population Exceptionally Rural – Any area of the US NOT included within the boundary of or fewer Census Urbanized Area or Urban Cluster having population in excess of 000. This includes Urban Clusters between and as well as Census Rural Areas. Rural – Any area of the US included within the boundary of Census Urban Cluster having population over 000 and not in excess of 000. 10
Mid Rural Any area of the United States included within the boundary of Census Urban Cluster over 000 and not in excess of 000. 001 20 Urban Area Any area of the United States included within the boundary of any Urbanized Area or Urban Cluster in excess of 000. 001 or more Enter every population center in which you provide your service in column 1. Place each Census Urbanized Area UZA and Census Urban Cluster UC on an individual line and include data printouts from the Census showing the population of each such area to support the population you enter in column 3. If you serve the entire urban area show the entire urban population in column four. If you serve only part of an urban area enter that portion in Column 4. Enter the entire Census Rural below population of the service territory on one line and show census data sheets to support that number. Show the census designation of the population center in column and enter the appropriate points from the table above in column 5. Enter the product of column times column in column 6. You must include the entire population of each Urbanized Area UZA and Urban Cluster UA in which you provide your service in column unless you demonstrate that your defined service territory excludes part of the UZA or UC. Find additional guidance in the Application Guide. An application for non fixed site project that does not include properly defined service territory documented by census data can not be scored and will be returned as ineligible. 1. Service Territory Population Centers List each urbanized area & urban cluster on separate line. Show the entire Census Rural Area on one line. 2. Census Designation 3. Census Population 4.Population inService Territory 5. Rurality Points 6. Product = Sum Rows 5 of column & including any additional rows from continuation sheets. SUM
Tab 3 Leveraging Worksheet Matching Funds – For more complete guidance see 3 in Section IV of the Application Guide The applicant must demonstrate an eligible match of at least 15% of the grant request. To be credited the proposed match must be for eligible purposes. If the Agency cannot fund an item if it were in the grant request we cannot accept it as match. As an applicant you submit proposed match and estimated score. The eligibility of the match and actual score is determined by the Agency. You must document your matching funds as described in the Application Guide. Place letters of financial commitment and other match documentation along with this form under TAB 3 of your application package. Each donor’s match as listed below must be supported by matching letter. If you have more than ten donors use another copy of this sheet and label it "continuation." Matches not properly documented under Tab 3 will not be credited. Depending on the consequent reduction of your match this could lower your score or make your project ineligible i.e. if resultant match is less than 15% Eligible Match Eligible Grant Request Points 15% Match ~ 30%
30% Match ~ 50% 50% Match ~ 75% 75% Match ~ 100% Match 100% Donor place documentation letter from each donor behind this sheet Proposed Match 1. Total proposed matching contributions sum of thru x. $
2. Total DLT Grant requested. $ 3. Match as Percent of Grant Request Line Line 100%. % Applicant’s Estimated Leveraging Score Enter Points from Scoring Table Tab 4 EZ EC Worksheet USDA EZ EC and Champion Community Worksheet See Section 4 of the Application Guide If any of your sites are located in USDA Rural Empowerment Zone USDA Enterprise Community or USDA Champion Community your application may be eligible for points in this category. Check these websites for USDA designated areas. www.ezec.gov ezec mainmap.html www.ezec.gov Communit champions.html
Ten points can be earned if at least end user site is within an EZ EC. Additional sites located in that or another EZ EC do not earn additional points. Five points can be earned if at least end user site is in Champion Community. Again additional sites located in that or another Champion community do not earn additional points. The maximum score an applicant can earn in this category is fifteen points for having at least one site in an EZ EC and another site in Champion Community. Remember that the two categories are mutually exclusive. There are no areas that are both an EZ EC and Champion Community so one site can not earn all fifteen points. List end user sites that are in either an EZ EC or Champion Community in the appropriate table below. Any end user site shown on this Worksheet must be consistent with the sites shown on the Rurality and NSLP Worksheets. To document the EZ EC or Champion Community status of the sites place printouts from the USDA websites shown above behind this Worksheet under Tab 4. If not documented under Tab 4 no points will be awarded in this category. USDA EZ EC designations use Census tracts. The Census tract information for each EZ or EC is available at the Web page listed above. You must supply the Census tract information if you wish to claim either EZ or EC status. End User Site Name EZ EC Name Census Tract End User Site Name Champion Community Name Applicant’s Estimated EZEC Score Enter Points from Scoring Table
Tab 1 Additional NSLP Worksheet See more complete information about additional NSLP see 1 in Section IV of the Application Guide The NSLP eligibility percentage on our NSLP Worksheet Tab 2 is. If this percentage is under 50% and you believe your NSLP eligibility percentage does not accurately reflect the economic conditions in your area compared to other areas with similar eligibility percentages you have the option to request additional points here. If the eligibility on your NSLP Worksheet is 50% or higher but you suspect that the percentage could drop below 50% after Agency review of your application you may also request these points. Such request will be acted upon only if your final NSLP eligibility is below 50% as determined by the Agency. Points awarded by the Agency in this category if any are based on the supporting information provided. Attach your supporting documentation behind this worksheet under Tab 1. Requests for Additional NSLP will not be considered if not accompanied by supporting documentation i.e. no Additional NSLP points will be awarded. I hereby request additional NSLP Points and have attached documentation behind this Worksheet to support my request. Signature of Authorized Representative Same person who signed the SF 424 Application for Federal Assistance
Additional NSLP Points for Agency Use Tab 2 Needs Assessment F – Community Needs Assessment and Project Benefits 1. Define the Community The ABC College Consortium is working collaborative of schools libraries museums hospitals businesses government agencies and economic development professionals serving counties in Connecticut and WA. All are working to spark the redevelopment of an area that has needed to rebuild the area. This project was developed by an education coalition within the Alliance. Our group serves 337 residents through fourteen schools social service agency and libraries.
Benefits 4. Direct Benefits A number of direct and related benefits can be anticipated for the students teachers allied professionals parents and community targeted. Increase in the number of students with access to the Internet organized instructional support online mentoring and authentic learning experiences relevant to the business and professional communities seeking workers in the 21st century; Increase the opportunities for professional development to strengthen the technology integration instructional support and subject matter expertise of teachers social workers and allied professionals involved with our schools; Work to increase post secondary enrollments through advanced placement stronger ties to community college and technical programs and involvement of parents in the career development planning for their children;
Help improve retention and graduation rates; Professional staff interaction and training with Change Management Team no vested in local politics; All students will have access through the Blackboard Academic Suite to new courses educational content enrichment communications shared inquiry and larger eLearning community; Professional development time travel and costs will be reduced; There will be 25% increase in the numbers of students seeking post secondary education by and; Efforts to address low self esteem and lack of confidence regarding educational attainment will be supported through larger community of experts and education partners. Related benefits include.
Participation in the growth of our regional economy; Addressing the issues of population decline with opportunities for youth to become involved with more "personalized" educational experience; Growing the number of qualified teachers and faculty; Growing the community experience across the region by sharing in the effort to improve the future for our youth and involve older community members in that process. Document Support for the project is provided by experts in the educational or health care fields. – See documentation in 2B D. Demonstrate that rural residents and other beneficiaries want the educational or medical services from the project. – See attachments 2C Tab 3
Innovativeness F Innovativeness of the Project We are using two innovations during this project that will spark others. Change Management Toolkit helping school administrators teachers and allied professionals to work as Virtual Teams for common constituency. We have erased the school district boundaries and identified region instead of the local focus which has been standard. The Change Management Toolkit will provide the planners with key methodologies to execute the deployment of new equipment software and training and work to sustain its deployment effectively. It also provides an opportunity to use cross functional teams to address challenges in schools. SMART Classrooms established in each school district all are without to motivate change in the way both students and teachers interact with educational content. The technologies used in this approach enable video conferencing web enabled instruction Forums online coursework blogs wikis access to Internet2 and other techniques. What is seen as innovative is that the technology will be modified by real time feedback and vendors put into competition as they do in industry to solve problems in short term and not just sell equipment. Also evaluations of the classrooms will be conducted with both students and teachers and feedback promoted through the Blackboard Academic Suite administered through the hub. Are there educational innovations proposed Yes organizational change strategies for the diffusion of innovations and measurements of technology integration management
Does the project use unique adaptations of technology to better meet the special needs of the project’s proposed service area or beneficiaries No Does the project have the potential to influence or promote changes in how distance learning can be delivered to an area. Yes for New Jersey where people are still bound by small town silos. What is innovative is that we have ignored the silos and planned as though they are not an obstacle instead used the small town technology plans that have been adopted by their boards of education to provide impetus for regional solution that reduces cost and delivers communications efficiently and effectively. Does the project use existing resources in new way. Yes just through our deliberations we have identified all the theatrical sites in the rural area began dialogues with their directors to collaborate on programming and support local school Tab 4 Cost Effectiveness F – Cost Effectiveness of the Project Discussions were held with vendors Alliance partners and financial professionals at the College. We have made the decision to purchase the equipment. These challenges were considered. John Smith State Director
U.S. Department of Agriculture Government Way Seattle WA Dear Mr. Smith. This letter confirms our recent conversations regarding your planned grant application to the Office of Distance Learning and Telemedicine. As the USDA representative for these grants in our state would like to further encourage your plans to move forward on this grant linking several communities and providing missing technologies to both schools and social services agencies. At our first meeting it was clear that your consortium was too small problem that you remedied in later weeks and now you have expanded the collaborative to include libraries museums and other public agencies that offer great opportunity to expand access to the public. We are pleased the read your application and know that you will meet the requirements for submission. Sincerely Harry Jones State Director Certificate Regarding Architectural Barriers
All facilities financed with RUS grants that are open to the public or in which physically handicapped persons may be employed or reside must be designed constructed and or altered to be readily accessible to and usable by handicapped persons. Standards for these facilities must comply with the Architectural Barriers Act of as amended U.S.C. et seq. and with the Uniform Federal Accessibility Standards UFAS Appendix to CFR subpart 101­19.6. As prospective primary participant recipient of financial assistance from RUS this organization commits to carry out RUS’ established policy to comply with the requirements of the above referenced law to the effect that all facilities must be readily accessible to and usable by handicapped persons. The Grantee hereby certifies that as prospective recipient under the Distance Learning and Telemedicine Grant and Loan Program it is in compliance or will be in compliance upon completion of the project with the above referenced law. or Print Name Title Certificate Regarding Flood Hazard Area Precautions
In accordance with CFR if the project is in an area subject to flooding flood insurance must be provided to the extent available and required under the National Flood Insurance Act of as amended by the Flood Disaster Protection Act of as amended U.S.C. 4001 4128. If applicable the insurance must cover in addition to the buildings any machinery equipment fixtures and furnishings contained in the buildings. RUS will comply with Executive Order Floodplain Management CFR Comp. p. and CFR 1794.41 of this chapter in considering the application for the project. Please check the appropriate line below. a The project is not located in 100 year flood plain; therefore no Flood Insurance is required. b The project is located in 100 year flood plain and the required insurance is or will be provided by. The Grantee hereby certifies that as prospective recipient under the Distance Learning and Telemedicine Loan and Grant Program it is in compliance or will be in compliance during construction and or installation of equipment and upon completion of the project with the above referenced law. Uniform Relocation Assistance and Real Property Acquisition Policies Act of Certification The Grantee assures that it will comply with the Uniform Relocation Assistance and Real Property Acquisition Policies Act of Uniform Act as amended U.S.C. 4601 4655 and with implementing Federal regulations in CFR and CFR 21. Specifically the Grantee assuresthat.
Whenever Federal financial assistance is used to pay for any part of the cost of program or project which will result in the displacement of any person; Fair and reasonable relocation payments and assistance shall be provided to or for displaced persons in accordance with sections and of the Uniform Act Relocation assistance programs offering the services described in section of the Uniform Act shall be provided to displaced persons and Within reasonable period of time prior to displacement comparable replacement dwellings will be available to displaced persons in accordance with section of the Uniform Act.
Date Signature of President or Au Certification Regarding Drug Free Workplace Requirements for Grantees Other than Individuals This certification is required by the regulations implementing Sections 5151 5160 of the Drug Free Workplace Act of 100 690 Title Subtitle D; U.S.C. et seq. CFR 3017.600. The grantee certifies that it will or will continue to provide drug free workplace by.
Publishing statement notifying employees that unlawful manufacture distribution dispensing possession or use of controlled substance is prohibited in the grantee’s workplace and specifying the actions that will be taken against employees for violation of such prohibition; Establishing an ongoing drug free awareness program to inform employees about. The dangers of drug abuse in the workplace; The grantee’s policy of maintaining drug free workplace; Any available drug counseling rehabilitation and employee assistance programs; and The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;
Making it requirement that each employee to be engaged in the performance of the grant be given copy of the statement required by paragraph ; Notifying the employee in the statement required by paragraph that as condition of employment under the grant the employee will. Abide by the terms of the statement; and Notify the employer in writing of his or her conviction for violation of criminal drug statute occurring in the workplace no later than calendar days after such conviction; Notifying the Agency in writing within calendar days after receiving notice under subparagraph from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice including position title to every grant officer on whose grant activity the convicted employee was working unless the Federal agency has designated central point for the receipt of such notices. Notice shall include the identification number of each affected grant; Page of
Certification Regarding Debarment Suspension and Other Responsibility Matters—Primary Covered Transactions This certification is required by the regulations implementing Executive Order Debarment and Suspension CFR 3017.5 10. The prospective primary participant certifies to the best of its knowledge and belief that it and its principals. are not presently debarred suspended proposed for debarment declared ineligible or voluntarily excluded from covered transactions by any Federal department or agency; have not within 3 year period preceding this proposal been convicted of or had civil judgment rendered against them for commission of fraud or criminal offense in connection with obtaining attempting to obtain or performing public Federal State or local transaction or contract under 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;
are not presently indicted for or otherwise criminally or civilly charged by governmental entity Federal State or local with commission of any of the offenses enumerated in paragraph of this certification; and have not within 3 year period preceding this application proposal had one or more public transactions Federal State or local terminated for cause or default. Where the prospective primary participant is unable to certify to any of the statements in this certification such prospective participant shall attach an explanation to this proposal. Name and Title of Authorized Representative Signature Organization Name Date Certification Regarding Lobbying for Contracts Grants Loans and Cooperative Agreements The undersigned certifies to the best of his or her knowledge and belief that.
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 Member of Congress an officer or employee of Congress or an employee of Member of Congress in connection with the awarding of any Federal contract the making of any Federal grant or loan the entering into of any cooperative agreement and the extension continuation renewal amendment or modification of any Federal contract grant loan or cooperative agreement. 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 Member of Congress an officer or employee of Congress or an employee of Member of Congress in connection with this Federal contract grant loan or cooperative agreement the undersigned shall complete and submit Standard Form LLL "Disclosure Form to Report Lobbying " in accordance with its instructions. Copies of this form may be obtained from RUS. The undersigned shall require that the language of this certification be included in the award documents for all sub awards at all tiers including subcontracts sub grants and contracts under grants loans and cooperative agreements and that all sub recipients shall certify and disclose accordingly. This certification is material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is prerequisite for making or entering into this transaction imposed by U.S.C. 1352. Any person who fails to file the required certification shall be subject to civil penalty of not less than $10 and not more than $100 for each such failure. Organization Name
Name and Title of Authorized Representative Signature Date Non Duplication of Services Certificate As prospective primary participant recipient of assistance from RUS this organization commits to carry out RUS’ established policy to comply with the requirements that no facilities using financial assistance will duplicate adequate established telemedicine services and or distance learning services. The Grantee hereby certifies that as prospective recipient under the said Distance Learning and Telemedicine Loan and Grant Program that it will not use RUS grant funds to duplicate any adequate established services as referenced above. Environmental Impact Certification Environmental Project Summary. This description should encompass all construction in the project no matter the source of funding. It should provide details of how the project will affect the environment wetlands farmlands floodplain cultural environment endangered species environmental quality and historic preservation. If additional space is needed continue on white bond paper and attach to this certification. CERTIFICATION hereby certify that the construction proposed in this application will not adversely impact the environment or historic preservation. Signature and Date Print or Type Title