Name of Grant Program: Massachusetts 21st Century Community Learning Centers Fund Code: 647-B1
– Supporting AdditionalLearning Time (for new ELT and OST sites)

Part III-B – Required Program Information – School/Site(FY17)

Please see the Funding Opportunity-Request for Proposals (FO-RFP) for additional information including:minimum eligibility requirements, allowable models for adding time,maximum funding request amounts and priorities for the use of grant funds.

Instructions for completing this document:

  • Questions are labeled as follows to indicate which applicants should respond, according to the model chosen for the respective site:
  • [ALL] – Schools/sites applying for Model 1 (ELT) AND Model 2 (OST) should respond.
  • [Model 1 (ELT) ONLY] – Only schools applying for Model 1 (ELT) should respond.
  • [Model 2 (OST) ONLY] – Only schools applying for Model 2 (OST) should respond.
  • Questions primarily focus on planning and implementation of school year programming. Funded applicants will be asked to more fully describe summer programming in the mid-year reporting.
  • Responses should be provided within this document leaving the questions above each response. All questions are shaded in gray and responses should be written in the white space below each question.
  • Please do not delete questions that are not applicable – this will re-number questions and may lead to confusion in responding to questions that reference earlier questions.
  • Please adhere to indicated page limits and do not change the font size or margins.
  • Narrative and/or bulleted responses are acceptable.

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Name of Grant Program:Massachusetts 21st Century Community Learning Centers Fund Code: 647-B1
– Supporting AdditionalLearning Time (ELT and OST)
SCHOOL/SITE IMPLEMENTATION PLAN

IMPORTANT NOTE: Applicants should submit ONE proposal with a separate School/Site Implementation Plan (Part III-B) for each school/site included. Information about the limits on the number of schools/sites for which an applicant may apply can be found in the FO-RFP.

Information on this page and the next page(and from page 2 in Part III-A) must be completed here AND submitted online using this link:

. Please submit only once per lead applicant.

School/Site Name:
School/Site Location / Address
School/Site Contact Name and Title:
Phone: / Email:
If the site is not a public school, please indicate the school(s) the students who will participate in the program attend.
Model Chosen (Place an “x” in the box that applies.)
Model 1 (ELT) / Model 2(OST)
Grade-level(s): (check all that apply)
  • For Model 1 (ELT), please indicate the grade levels served by the school.
  • For Model 2 (OST), please indicate the grade levels of the students targeted for the program.
/ K-5
6-8
9-12
Program Overview:
Please provide a brief description (no more than 150 words) of the proposed program, highlighting engaging practices to be offered.
The description should begin with the following sentence, filling in the blanks with the appropriate information:
[District/Lead Applicant Name] proposes to implement [ELT or OST] at [School/Site Name], serving [# of students] in grades [grade levels].
A sample description can be found in the endnotes.[i]
Note: This description may be posted on the Department’s website.
Please check the appropriate box(es), indicating how the site meets the grant eligibility requirements[ii]: / School Wide Title I (SW) / ≥15% of students economically disadvantaged (ED)
Competitive Priority:
(Place an ‘x’ in the box for each that applies.) / Proposing to implement more time in a school classified as Level 3, 4, or 5 for 2015 under Massachusetts'district and school accountability and assistance system. / Please indicate the school’s 2015 level below:
Proposing to serve youth in schools/communities with higher percentages of students who are ED, as indicated at the Department's School and District profiles page for 2015-2016. / Please indicate the school’s ED% below:
Submitting this application in full partnership that includes a school district, and a community-based organization(s) or other public or private entity. Please list those partners below:
The following competitive priorities apply to Model 1 (ELT) Applicants Only
Reviewers will look for evidence of meeting these competitive priorities in the responses to the question(s) indicated in parentheses, respectively.
Propose to implement a blended learning educational model. (Question 7)
Propose to implement an expanded school calendar and/or a longer summer program. (Questions 18 and 19)
Propose to implement a teacher career ladder model. (Question 8)
Propose to implement service-learning and/or project-based learning during core academic time. (Question 7)
Propose a creative schedule that includes opportunities for enrichment that are not just at the end of the school day. (Question 19)

Planning Process and Rationale for Additional Time: (3 pages maximum)

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Name of Grant Program:Massachusetts 21st Century Community Learning Centers Fund Code: 647-B1
– Supporting AdditionalLearning Time (ELT and OST)
  1. [ALL] Describe the school’s/site’s planning processfor implementing ELT or OST[iii] programming that offers engaging learning opportunities[iv]and supports SEL; including the process fordeveloping this proposal. Include a list of the team members that contributed to developing the proposal and their respective roles. Describe the process for gathering input and “buy-in” from key stakeholders (including teachers/staff, parents, students and community partners).
  1. [ALL] Describe the school’s/site’s plans and structures for overseeing, monitoring, and evaluating the implementation of ELT or OST. Include a list of implementation team members and their respective roles.Describe the qualifications/credentials the program will seek for a site-coordinator; or, if that role already exists, provide the current site-coordinator’s qualifications/credentials. If the required district coordinator, described in Question 4 of the District Summary (Part III-A), will assume this role, please indicate as such.
  1. [ALL] Briefly describe the school’s/site’s specific needs and priorities related to students’ academic achievement, SEL, civic engagement, wellness, etc. that will be addressed through the engaging instructional practices and academic enrichment opportunities offered as a result of ELT or OST. Include relevant data that supports the need in the identified areas.

Proposed Typical Day (1 page maximum)

  1. [ALL] Provide a narrative describing what a typical day will look like at the proposed school/site. The response to this question should be in the form of a story that describes a student’s experience in the newly implemented OST or ELT. The narrative should include: an overview of the schedule, examples of engaging enrichment activities offered, SEL supports and practices(including highlights of expected peer/peer and adult/student interactions); and any other examples that highlight proposed grant-funded activities.The specifics of program scheduling and implementation are requested in the following questions.

Implementing Additional Time (15 pages maximum for Questions 5-17, including the Question 7chart):

  1. [ALL]Describe the specific targeted population to be served through grant-funded programming/activities.[Model 1 (ELT) applicants should only respond if school yeargrant-funded activities will not benefit ALL students.]

5a. [Model 1 (ELT) ONLY] If the school housesspecialized programming for special populations of students (e.g. students with disabilities, English Language Learners, etc.), please describe how the school and district will ensure that needs of these students resulting from additional time will be met, including financial and programmatic considerations.

  1. [Model 2 (OST) ONLY]Describe planned outreach strategies to recruit and retain the selected population of students in the proposed OST program. Understanding that recruiting and retaining middle and high school students can be particularly challenging, applicants proposing to serve these grades should describe specific outreach strategies and/or programmatic practices that may be used to increase enrollment and/or sustain student attendance and active participation (e.g.,offering core/elective credits, etc).
  1. [ALL] Using the chart that follows, briefly describe the engaging instructional practices and academicenrichment opportunities that will be implemented to address the identified needs/priorities described in the questions above. Responses may include a description of teaching/learning strategies that will be implemented by educators as well as examples of the types of enrichments/projects that will be offered.

Reminder:Grant-supported activities should align to the school’s described needs/priorities, but also to the grant priorities. Please see the Priorities section in the FO-RFP document.

Applicants are required to implement service-learning or project-based learning.[v] A plan for doing so should be included in the chart.

INSTRUCTIONS for completing the chart:

  • In the “Proposed Activities” column, include up to 1-2 paragraph descriptions for each proposed activity. (See examples provided as a guide for what to include.)
  • In the “Needs/Priorities…” column, include 5-10 words describing how the activity supports one or more of the needs/priorities identified in Question 3 above, as well as the chosen SAYO outcomes.
  • In the “New?...” column, indicate whether the activity is either: New, Enhanced, or Ongoing
  • In the “Funding?...” column, indicate either: Fully, Partially, or Not (to indicate the extent to which the activity is funded by this grant request). For those activities that are “Partially” or “Not” funded through this grant, provide a brief description of how they will be supported.
  • Add additional rows as needed. (Select an entire blank row, right click, select “Insert Row Above” or “Insert Row Below”)
  • Cells will automatically expand (down) to fit what is typed. Please do not change the column widths.

Proposed Activities / Needs/Priorities/ SAYO Outcomes Addressed / New? Enhanced? Ongoing? / Funding?
(Fully, Partially or Not)
EXAMPLE 1: All enrichment providers, including school staff and partners, will be trained in project-based learning (PBL) and are expected to incorporate this teaching and learning approach, as appropriate, into their offerings. / ELA, higher-order thinking, relationship skills / New / Partially. Additional local PD funds will be used to include providers in trainings on PBL.
EXAMPLE 2: STEM is Awesome. Middle and elementary students will participate in this enrichment, offered 2 days/week for each grade-level. Students and staff will use inquiry to tackle daily questions that prompt them to explore, watch, wonder and work together to respond to their environment. Students will engage in hands-on activities, have take-home projects to work on with their families at home, and have opportunities to write about and reflect on their learning. / Multi-disciplinary, mathematics, self-awareness / New / Fully

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Name of Grant Program:Massachusetts 21st Century Community Learning Centers Fund Code: 647-B1
– Supporting AdditionalLearning Time (ELT and OST)
  1. [Model 1 (ELT) ONLY] Briefly describe the school’s plan for staffing ELT. Include information about changes to teachers’ scheduled hours and workload, as well as how additional hours will be compensated. Also include information about how qualified partners, vendors, and volunteers will be involved in staffing an expanded day. Note: If applicable, include planned or secured changes to collective bargaining agreements.
  1. [Model 2 (OST) ONLY] Describe the qualifications/credentials the program will seek for program staff to meet the needs of the targeted population (as described in the responses to Questions3 and 5 above), including students on Individualized Education Programs and English Language Learners.

10b. [Model 2 (OST) ONLY] Describe plans forrecruiting and retaining qualified staff.

10c. [Model 2 (OST) ONLY] Describe plans for providing CPR and first aid training to program staff, within at least two months of employment. (Federal requirement.)

  1. [ALL] Describe the structure and opportunities for professional development[vi] and collaboration that will support educators in the implementation of proposed activities, as well as continuous program improvement. Describe plans for including partners, contracted providers and volunteers in these opportunities.
  1. [ALL] Describe plans for building and strengthening partnerships among schools/sites and communities in order to advance common goals for student success. Note:Only include here school-level partnerships that were not already described in Part III-A (District), Question 7.
  1. Describe plans to engage families[vii] in meaningful ways to better support student learning and development. If applicable, please describe how grant funds will be used to support family engagement/involvement. Reminder: Applicants are encouraged to allocate at least five (5) percent of the total grant request to either family engagement/involvement OR SEL.
  1. Describe plans to implement strategies that support students’ SEL.[viii]If applicable, please describe how grant funds will be used to support SEL. Reminder: Applicants are encouraged to allocate at least five (5) percent of the total grant request to either family engagement/involvement OR SEL.
  1. [ALL] If the program plans to contract with any outside vendors/community based agencies, describe the criteria used for selecting contracted providers and how the services they will provide connect to and support identified needs and selected SAYO outcomes.
  1. [ALL] Describe how the program will ensure that students travel safely to and from the program.

Note for Model 1 (ELT) Applicants: Federal regulations require that all 21st CCLC grantees describe a plan for transportation of students. Please describe how students travel to and from school and highlight any proposed changes as a result of ELT.

  1. [ALL]Provide a brief (1 paragraph or up to five (5) bullets) description of the current plans for offering a required summer program, including the number of hours proposed. Note: Funded applicants will submit a summer program plan with mid-year reporting.

Note for Model 1 (ELT) Applicants: Please also provide a brief description of current plans to offer school vacation week programming, if applicable as part of offering the required 300 hours.

  1. [Model 2 (OST) Only] Describe the location and space in which the OST program will take place. Describe how the program will ensure a welcoming environment with necessary resources to implement activities, stimulate learning, and provide space to exhibit students' work and projects. Please refer to theAddendum A - Grant Assurances document in the FO-RFP Required Forms sectionregarding space requirements.
  1. [Model 1 (ELT) ONLY] Use the chart below to provide information about the school hours/daysrequired for all students.(1 page maximum) Please see the Implementation Models section of the RFP document for hours requirements.

Pre-ELTSY16 (2015-2016) (or 2014-2015 if ELT was newly implemented in 2015-2016)
Date school began: / Date school ended:
Enrollment / Grades Served:
School Start/End Time [insert rows if needed] / Hours / # of days / Total Hours
Total # of Hours (Pre-ELT)
PROJECTED ELT SY17 (2016-2017)
Date school begins: / Date school ends:
Anticipated Enrollment: / Anticipated Grades Served:
School Start/End Time [insert rows if needed] / Hours / # of days / Total Hours
Total # of Hours (School Year ELT)
PROJECTED SUMMER/VACATION PROGRAMMING FY17
# of Youth to be Served / # Hours/ day / # days/ week / # of weeks / Total Hours / Days of Week
(e.g., M-F) / Program Times
School Year (vacation weeks) / Start Time:
End Time:
Summer / Start Time:
End Time:
Total # of Hours (Summer/Vacation):
  1. [Model 1 (ELT) ONLY] Provide the following schedules. Proposed SY17 schedules should reflect the expanded learning programming required for all students (not the summer/school vacation week programming.)(Schedules should be inserted into this document – 5 pages maximum):
  1. Pre-ELT (SY16) Student Schedule (or, provide SY15 if ELT was newly implemented in SY16)
  1. Pre-ELT (SY16) Teacher Schedule (or, provide SY15 if ELT was newly implemented in SY16)
  1. Proposed (SY17) Student Schedule
  1. Proposed (SY17) Teacher Schedule
  1. [Model 2 (OST) ONLY] Use the chart below to provide the anticipated OST program schedule.(1 page maximum, Questions 20-21)

Applicants may propose any schedule configuration that meets the following requirements:

  • Operate for a total of 400 hours during theschool year and summer
  • Operate a minimum of 4 days/week during school year and summer
  • Funds cannot be used to support only before school and/or summer programming.
  • If applicable, before-school programming must run for at least one (1) hour each morning offered, serve a consistent group of students, and conclude before the school day begins.
  • If applicable, school vacation week programming must serve the same students served in OST programming.

Please Note:Drop-in programs are not allowed.

Sample schedules are provided in the endnotes below for reference.[ix]

It is not expected that all students will attend all offered hours; however students are expected to participatefor the following minimum numbers of hours, on average during the school year, and approximately 80% of the time during the summer:

Elementary School – 100 hoursMiddle School – 90 hoursHigh School – 80 hours

# of Youth to be Served / # Hours/ day / # days/ week / # of weeks / Total Hours / Days of Week
(e.g., M-F) / Program Times
School Year (before school) / Start Time:
End Time:
School Year (after school) / Start Time:
End Time:
School Year (vacation weeks)
Summer / Start Time:
End Time:
Total # of Hours Offered: / Must be a minimum of 400 hours.
  1. [Model 2 (OST) Only] To as ensure that students are attending for the required average number of hours, describe the student attendance policies for both the proposed 21st CCLC OST and the summer program, including how often students will be required to attend.

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[i] Sample Program Overview: “Anytown Public Schools proposes to implement OST at Ourtown Middle School, serving 50 students ingrades 6-8. Students will engage in programming that includes STEM project-based learning, health and wellness education, academic support and college and career readiness activities.”

[ii]Applicants should use the information on the Department's School and District profiles page for 2014-2015 for the proposed school(s). Eligible schools’ School Title I Status will be “Title I (SW)”. Schools with a status of “Non-Title I school (NT)” or “Title I School (TA)” are not eligible to apply unless the percentage of ED students meets the above criteria.