PI-2976Page 1

V. NARRATIVE (cont’d)
/ Wisconsin Department of Public Instruction
IMMIGRANT CHILDREN AND YOUTH GRANT APPLICATION/PLAN
PI-2976 (Rev. 03-18) / INSTRUCTIONS: Complete and return original and one copy no later than MAY 4, 2018, to:
WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION
BILINGUAL/ESL PROGRAM
ATTN: IDA KUKIMIYA
IMMIGRANT CHILDREN AND YOUTH PROGRAM
PO BOX 7841
MADISON, WI53707-7841
For Project Year:July 1, 2018toJune 30, 2019
(Including Summer)Month/YearMonth/Year
Collection of this information is a requirement of ESEA 2001, Section3114(d)(1).
For additional information, contact Ida Kukimiya at (608) 267-9267 or
Application Type Check One.Continuation New
I. GENERAL INFORMATION
Title of Project
Applicant Agency / Mailing Address Street, City, State, Zip
Contact Person / Title / Telephone Area/No.
E-Mail / Fax Area/No.
Program Coordinator If other than contact person / Title / Telephone Area/No.
E-Mail / Fax Area/No.
Program Coordinator’s Mailing Address, Street, City, State, Zip / DUNS Number
II. ASSURANCES
The applicant hereby gives assurance to the State Superintendent of Public Instruction that: All must be checked.
1.The Immigrant Children and Youth Grant funds will be used to meet the cost of providing the authorized supplementary educational services to immigrant students.
2.The administering agency, after consultation with appropriate officials, shall provide for the benefit of students enrolled in nonpublic schools secular, neutral, and nonideological services, materials, and equipment necessary for the education of immigrant children and youth enrolled in the nonpublic elementary or secondary schools, or Institutions of Higher Education (IHEs).
3.The control of Immigrant Children and Youth Grant funds and the title to any materials, equipment, and property repaired, remodeled, or constructed with these funds shall be in an administrating agency for the uses and purposes provided in this application.
4.The provisions of services to immigrant children and youth enrolled in programs, elementary and secondary schools, and IHEs shall be provided by employees of an administrating agency or through contract by that agency with a person, association, agency, or corporation who or which, in the provision of such services, is independent of that agency and of any religious organization; and any employment or contract shall be under the control and supervision of the administrating agency, and these funds shall not be commingled with federal, state, local, or private funds.
5.The agency shall submit periodic reports of expenditures, end of year report, and shall provide the DPI or federal government with information or records requested relative to the expenditures of the Immigrant Children and Youth grant funds and/or services rendered. The agency shall attend department scheduled meetings.
6.Programs and services offered will be conducted in accordance with all federal, state, and local laws and all requirements set forth in policies and procedures as issued by the Wisconsin Department of Public Instruction.
7.This discretionary grant will not allow carryover.
8.Administration costs of the grant should not exceed two percent (2%) (administrative costs and indirect costs).
III. SIGNATURE
Name of Agency Administrator / Signature of Agency Administrator
 / Date SignedMo./Day/Yr.
IV. NUMBER OF STUDENTS TO BE SERVED

Instructions

In column one, list how many refugee students are in refugee status. In column two, list the national origin of immigrant children and refugees to be served under this program. In column three, list total number of years the students have been in your district. In column four, list the total number of immigrant children.

Note

1.For confidentiality, do not put individual children’s names or identifying information.

2.Make additional pages as necessary.

Pre-K-12th Grade Children/Students / Place of Origin / Total Number of Years the Immigrant Students Have Been in Your District / Total Number of Immigrant Children
New Arrivals
Second Year
Third Year

PI-2976Page 1

V. NARRATIVE (cont’d)
V. NARRATIVE
Format Instructions: For each of the items listed, describe how the project will address the specifics of that item. Responses should be concise and to the point.
A.Invitational Priorities:Summer/after school programs, parent training, activities coordinated with community-based organizations (CBOs), institutions of higher education (IHEs), and newcomer programs/activities.
List the supplemental activity selected (e.g., after-school tutoring). You may choose more than one activity.
B.Selection Criteria
1.Needs for the Project:
  • Demographic data including number of immigrant children and youth to be served and languages. Provide a data table showing a significant increase of immigrant children and youth for at least a two-year period.
  • Comparison of academic achievement data of immigrant children and youth and their English speaking peers as measured by reliable and valid tests or assessment instruments.
  • Performance data on English proficiency and literacy skills as measured by reliable and valid tests or assessment instruments.
  • Summary of clearly specified needs including, but not limited to, the following areas: (1) academic achievement; (2) English language development; (3) native language support in content area instruction; (4) capacity building (professional development); and (5) parent engagement.

2.Quality of Project Design
  • Goals and expected outcomes that are clearly specified and, to the extent possible, measurable with reliable and valid tests or assessment instruments.
  • The extent to which the proposed project is designed to build capacity/staff development and yield results that extend beyond the period of the grant.
  • The extent to which the proposed project will collaborate with institutions of higher education, community-based resources, and state and federal resources.

3.Timeline
  • Describe the anticipated timeline of the project or activity including milestones, responsible persons, and/or participants.

4.Quality of Project Evaluation
  • Describe the process that is in place for evaluating the effectiveness of the project or activity supported with Title III Immigrant Children and Youth. Measures may be formative or summative and should link back to the specific project goals and objectives. Reliable and valid assessment instruments should be used to the extent possible. Link back to specific project goals and objectives.

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VI. BUDGET
Title III, Part A, Immigrant Children and Youth
Applicant Agency / Grant Period / Date Submitted
Beginning / Initial Request / First Revision / Second Revision
Project Number For DPI Use Only / Ending
Budget Revisions: Submit a copy of this page, with appropriate revisions included. (Attach this to a brief letter of justification.) Note: Submit request at least 30 days prior to expenditure of grant monies. June 30 is the final date for submission of revisions.
WUFAR Function / WUFAR Object / Amount Requested / First Revision / Second Revision
Instructions (100 000 Series)
Activities dealing directly with the interaction between instructional staff and students. / a.Salaries (100s)
b.Fringe Benefits (200s)
c.Purchased Services/Tuition (300s)
d.Non-Capital Objects (400s)
e.Capital Objects (500s)
f.Other Objects (e.g., fees) (900s)
TOTAL Instruction / $0 / $0 / $0
Support Services—Pupil and Instructional Staff Services (in 210 000 and 220 000 Series)
Support services are those which facilitate and enhance instructional or other components of the grant. This category includes staff development, supervision, and coordination of grant activities. / a.Salaries (100s)
b.Fringe Benefits (200s)
c.Purchased Services (300s)
d.Non-Capital Objects (400s)
e.Capital Objects (500s)
f.Other Objects (e.g., fees) (900s)
TOTAL Support Services—Pupil/Instructional Staff Services / $0 / $0 / $0
Support Services—Administration
(Associated with functions in 230 000 series and above.) Includes general; building; business; central service administration, and insurances. / a.Salaries (100s)
b.Fringe Benefits (200s)
c.Purchased Services (300s)
d.Non-Capital Objects (400s)
e.Capital Objects (500s)
f.Insurance (700s)
g.Other Objects (e.g., fees) (900s)
TOTAL Support Services—Admin. / $0 / $0 / $0
Indirect Cost / Approved Rate% / $0.00 / $0.00 / $0.00
TOTAL BUDGET / $0.00 / $0.00 / $0.00
DPI Approval / Signature of DPI Reviewer
 / Date Signed Mo./Day/Yr.