The Online Version of This Application Employs Skip Logic

THE ONLINE VERSION OF THIS APPLICATION EMPLOYS SKIP LOGIC.

YOU WILL NOT ANSWER EVERY QUESTION.

Use this word document to help you prepare for the online application.

You can fill it out and then cut and paste into the survey monkey application.

Do NOT turn this document in.

When you see “click here” go to tinyurl.com/smcsrtsgrant

for the items you need to download.

1. Introduction: Safe Routes to School Call for Projects

BEFORE you begin this survey, click HERE to read the call letter for 2017-2018 Safe Routes to School Projects, print out a pdf of the application, a menu of SRTS vendor services and ALL of the forms and resources you will need to complete this application. You will be uploading some documents to this application.

Throughout the application, you will see "click HERE invitations." If you click on them while you are filling out the survey, you may lose information you have entered. PRINT OUT EVERYTHING YOU NEED BEFORE STARTING THE APPLICATION.

You will NOT be able to start the online application, save your answers and go back to it at a later time. Once you begin it, you will need to finish it. If you have ANY issues with the online application, please contact

Remember to UPLOAD your project COVER LETTER below.

2017-2018 Safe Routes to School Project Application

2. Telling the Story...

2017-2018 Safe Routes to School Project Application

If you have read through the pdf of the application, you may be wondering how to answer all of the questions for every single one of your schools, especially if you are in a large district with schools in various locations. If this is the case, please consider a representative sample of your schools to tell the story of your district and why Safe Routes to School is needed.

3. Organization Information (School/School District/CBO)

*Name of primary contact person for this application

First Name

Last Name

* Title of primary contact person

* Name of organization

* Business Address Street Address

City

State

Zip Code

Phone Number of primary contact person

*Email Address of primary contact person

2017-2018 Safe Routes to School Project Application

4. Project Information

*Project Type

Non-Infrastructure Only

Non-Infrastructure and Small Capital Infrastructure

* Project Title

* Project Abstract (100 words or less)

-2018 Safe Routes to School Project Application

5. School District/Organization

List information regarding the school district, individual schools or group of schools that will benefit from this project.

* Name of School District

* LIST Name(s) of School(s)

If you are applying as an individual school, the information you enter below is only for YOUR school. If you are applying as a district, please enter district information.

* Total student enrollment

* Students included in unduplicated count

* Percentage of English language learners (do not include % sign in your answer) * Percentage of students eligible for free or reduced priced meals under NSLP (do not include % sign in your

answer)

* Percentage of foster youth(do not include % sign in your answer)

2017-2018 Safe Routes to School Project Application

6. Where Students Live

If you are applying as an individual school, the information you enter below is only for YOUR school. If you are applying as a district, please enter district information. If your district is large, use a representative sample of schools to enter an average for 5 - 6 schools.

* Percentage of students living within 1/2 mile of school (do not include % sign in your answer)

*Percentage of students living 1/2 mile - 1 mile from school (do not include % sign in your answer) * Percentage of students living more than 1 mile from school (do not include % sign in your answer)

*Additional information regarding where students live. Please include any topographic/geographic barriers that affect travel to school (i.e. along a major arterial/steep hills)

7. Identified Coordinator

*Has your organization identified a Safe Routes to School coordinator for the 2017-2018 school year?

Yes

No

8. Date of Identification

*By what date will a coordinator be identified?

Date MM/DD/ YYYY

2017-2018 Safe Routes to School Project Application

9. Safe Routes to School 17-18 Coordinator Information

* First and Last name of identified coordinator for 2017-2018

* Title of identified coordinator

* 2017-2018 Coordinator's Contact Info Name

Address

Address 2

City/Town

State

Zip code

Email Address

Phone Number

10. Safe Routes to School Experience (task force)

* Is there a Safe Routes to School task force/committee or a transportation task force/committee for your organization?

Yes

No

11. SRTS Task Force

*How often does the task force/committee meet?

monthly

quarterly

Other (please specify)

* Please LIST the names and titles of task force/committee members

12. Safe Routes to School Experience

*Does your organization currently have a Safe Routes to School program?

Yes

No

13. Safe Routes to School Experience (benefits/challenges of current program)

* How has your Safe Routes to School program benefited the students in your community?

* What has been the biggest challenge for your Safe Routes to School program?

What * are you most proud of in your Safe Routes to School program?

* Indicate how sustainable your SRTS program would be without SMCOE_C/CAG funding

Not sustainable Sustainable

14. Ped/Bike Issues and Challenges

* Describe the current risks or obstacles to walking or biking to and from the school site(s) in your community. Include infrastructure issues and/or crime/violence on the route to school.

Has a walk audit been conducted at the school(s) this grant would serve? *

Yes

No

2017-2018 Safe Routes to School Project Application

15. Walk Audit

* When were the walk audits conducted? LIST school name(s) and year of walk audit

* LIST NON-INFRASTRUCTURE recommendations from the walk audits for each school that have NOT been addressed.

* Reasons NON-INFRASTRUCTURE recommendations have not been addressed (150 words or less) 17

* LIST INFRASTRUCTURE recommendations from the walk audit(s) for each school that have NOT been addressed.

* Reasons INFRASTRUCTURE recommendations have not been addressed (150 word or less)

16. Safe Routes to School Policies/Activities

* Which of the following bicycle/walking policies and infrastructure are already in place at your school(s)/district? (Check all that apply.)

designated pick up/drop off areas

policies and procedures around pick up/drop off

crossing guards

bike racks or designated bike parking

student safety patrol and/or kiddie valet

adult safety patrol and/or valet

school bus

Samtrans school bus route

district policy supporting walking/biking

policy (school or district) banning bicycling to school

pedestrian flags at designated crosswalks

NONE of the above

Other (please specify)

2017-2018 Safe Routes to School Project Application

* Which of the following non-infrastructure activities/projects have been carried out by your school/district/organization?

bike/ped safety assemblies/workshops for students

bike rodeos

bike/ped safety assemblies/workshops for parents

in class bike/ped education

school encouragement events

student travel tallies

SRTS parent survey

bike/ped related task force and/or committee meetings

bike/ped route maps

infrastructure improvements related to walking/biking

NONE of the above

Other (please specify)

*Please comment on the frequency of the non-infrastructure activities/projects (you checked off above) that have been carried out by your school/district.

17. Funding

* Which of the following sources have funded your efforts to help your students walk and/or bike to school safely?

SMCOE_C/CAG SRTS grant

Healthcare District Grant

City Grant

Transit Authority Grant

Active Transportation Grant

Metropolitan Transportation Grant

School District Funds

NONE of the above

Other (please specify)

*Are you able to provide the percentage of students in your organization who have demonstrated a shift in mode of travel due to school sponsored walk/bike education and activities?

Yes

No

18. Student Travel Mode

* Create and upload a table (see sample below) with the percentage of students who have demonstrated a shift in mode of travel due to school sponsored walk/bike education and activities.

*Please provide a brief explanation of the shift in mode of travel. Some things to consider in your explanation...did the changes occur as a result of various encouragement and educational activities or is the data primarily from walking/biking encouragement days?

19. Impact

* Which grade levels, in the school/district population, will be impacted by the various elements of the SRTS program you are proposing (education, encouragement events, etc.). For instance, if only one or two grade levels of students will participate in bicycle and other bike/ped education, note those grade levels. PLEASE ONLY LIST GRADE LEVELS.7-2018 Safe Routes to School Project Application

Bike/Ped education participation :

Environmental education participation related to Safe Routes to School:

Walking/biking encouragement day participation:

Other Safe Routes to School related activities (Please specify below.):

Please specify "Other" from above question.:

* How will this funding impact your school/district and the surrounding community? (200 words or less)

* LIST community partners who will support your Safe Routes to School efforts

* How will you garner community support for SRTS in 2017-2018? Please include an explanation of how you will engage stakeholders. (200 words or less)

* How involved are parents at your school(s) or district?

Not Involved Very Involved

Additional information regarding parent involvement. (200 words or less)

20. Equity

*What equity issues exist in your school/district and how will receiving this grant help address those issues?

Click HERE to read an article about how equity can be integrated into Safe Routes to School programming.

21. Action Plan

Action Plan

Outline your goals and proposed action steps and person(s) who will be responsible. Ideally, you will have at least one goal for most of the E's of Safe Routes to School. Click HERE to see an explanation of each E.

Please click on the link below for the Action Plan template and scroll down to "Additional Grant Forms." Download it, fill it out, and then upload it to this application.

Click HERE for the action plan template.

*Upload Action Plan template here.

Choose File Choose File

*Are you applying for small capital infrastructure funds in addition to non-infrastructure funding?

Yes

No

Small capital infrastructure projects include but are not limited to:

-permanent signage

-paint for school parking lot to direct traffic flow

-paint for curb to designate drop off zones (requires city approval)

-traffic calming measures in school parking lot

-adding gates to existing fences

-bike and skateboard parking

-paths to increase access to school site

-crosswalks on school property

2017-2018 Safe Routes to School Project Application

22. Small Capital Infrastructure Projects - Description and Budget

If you will be applying for small capital infrastructure funding, describe the proposed infrastructure solution to the issues and challenges described previously.

Please note:

* Project location, maps may be attached

* Whether or not permission has been obtained

* If the project was recommended in an audit report

* If plans have already been developed

* Provide a description of the work to be completed and describe the proposed infrastructure solution to the issues and challenges described previously.

Projects on city property must have city approval. Include a letter of support from the city for any project that will be on city property.

* Small Capital Infrastructure Project Description

* If applicable, upload project location map or pictures of the location here.

Choose File Choose File

SMALL CAPITAL INFRASTRUCTURE PROJECTS: Examples of small capital infrastructure projects include: paint to identify drop-off and pick-up areas, permanent signage to address safety issues, adding gates to existing fences to provide access, walkway lighting, pathway construction, etc. All small capital infrastructure projects are required to be located within the public right of way. preferably on lands owned by the public (or private) school or school districts. Projects that are located within a city/town, county or state right ow way must include a letter of support from the right of way agency with the application. Projects may not be "maintenance" related.

Follow the link to the budget template. Use the template to outline proposed project expenditures. If you are applying for both non-infrastructure and small capital infrastructure funds, please upload a budget for each.

Click HERE for the budget template. Download, fill it out and then upload it to this application.

*

Upload SMALL CAPITAL INFRASTRUCTURE budget here.

Choose File Choose File

2017-2018 Safe Routes to School Project Application

23. Proposed Project and Budget (Non-Infrastructure)

Eligible projects will be school-based, non-infrastructure projects in San Mateo County categorized as education, encouragement, enforcement and evaluation. Eligible projects may also include a funding request for small capital infrastructure improvements.

The maximum total grant amount per indivual school applicants is $9,000. The maximum amount per district is $60,000. Additional funding guidleines are listed below:

* Walk Audit - $5,000 per school site

* Route Map - $4,500 per school site

* Program Coordinator - up to $5,000 per school site

* Teacher Stipends for Program Coordination - up to $2,000 per school site (dependent on scope of work, number of students served and student population)

* Education Services - up to $3,000 per school sites for vendors from the approved vendor list

NON-INFRASTRUCTURE PROJECTS: Examples of non-infrastructure projects included development and implementation of programs and projects such as: walking school buses, school crossing guard training and equipment, encouragement programs, bicycle rodeos, bicycle trains, bicycle and walking route maps.

Click HERE for the budget template. Download, fill it out and then upload it to this application.

*Upload NON-INFRASTRUCTURE budget here.

Choose File Choose File

24. Application Submission

TERMS AND CONDITIONS OF GRANT APPLICATION

Click HERE to read the Call for Projects Letter.

* By clicking the submit button, I have read and understand the terms of the call for projects as outlined in the Call For Projects Letter.

Yes

No - If you click this button, you will be disqualified and will not be able to complete the application.

25. Signature Page and Letters of Support

Please print the names and provide the necessary signatures on the signature page prior to submitting this application.

Click HERE for the signature page.

*Upload the signature page here.

If you would like to upload a letter of support from a community partner, please do so here.

If you would like to upload a letter of support from a community partner, please do so here.