PI-7801-A Four-Year-Old Kindergarten (4K) Start-Up Grant Continuation

PI-7801-C Page 1

/ Wisconsin Department of Public Instruction
FOUR-YEAR-OLD KINDERGARTEN (4K)
COMMUNITY APPROACHES IMPLEMENTATION VERIFICATION FOR START-UP AND
CONTINUATION FUNDING
PI-7801-C (Rev.03-18) / INSTRUCTIONS: Complete and return with original signatures. Retain one copy for your files. Return original byAPRIL 13, 2018, to:
WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION
ATTN: SHERRY KIMBALL
EARLY CHILDHOOD CONSULTANT
PO BOX 7841
MADISON, WI 53707-7841
Cycle10
2017-18 START-UP
AND
2018-19CONTINUATION
Collection of this information is a requirement of s.121.02, Wis. Stats.
For additional information, contact

Grant Submission—Steve Kretzmann, Education Specialist, (608) 267-9278 or e-mail at
Program—Sherry Kimball, Early Childhood Consultant, (608) 267-9625 or e-mail at

I. GENERAL INFORMATION
Applicant School District / Mailing Address Street, City, State, ZIP
4K Coordinator, Principal, or Contact Person / Title
E-Mail Address / Phone Area/No.
Grant Contact If other than contact person. / Title
E-Mail Address / Phone Area/No.
II. START-UP GRANT CONTINUATION
For Cycle 10 funding, districts must implement 4K as described in their approved start-up application. Indicate the status of your district’s 4-year-old kindergarten (4K) implementation and intent for continued involvement in the Start-Up program.
Check the appropriate boxes
1.A.In 2017-18,our district is implementing 4K using the community approaches as defined in our approved grant. We assure that we are eligible to remain in the Start-Up Grant Program. If this box is checked, Section III below and Sections IV and V on page 2. Must be completed.
1.B.For the 2018-19 school year, we will continue to implement 4K using community approaches. If this box is checked, Section III below and Section VIon page 2 must be completed.
1.C.In 2017-18, our district is implementing 4K using a school-based model as defined in our approved grant. We assure that we continue to be eligible for 2017-18 certification funding. If this box is checked, SectionIII below and Section IV on page 2 must be completed.
2.In 2017,ourdistrict did not implement 4K as defined in our approved grant. Since we are not implementing our approved grant, we are withdrawing our application for any start up or continuation funding through this grant. If this box is checked, complete Section III below only. Also provide a brief explanation about why you discontinued the utilization of community approaches.
III. SIGNATURES
Signature of 4K Coordinator or Designee
 / Date SignedMo./Day/Yr.
Signature of School District Administrator
 / Date SignedMo.Day/Yr.

Complete sections on the following page if number 1was checked on question II above.

IV. VERIFICATION THAT DISTRICT ESTABLISHED A 4K PROGRAM THAT MEETS 4K STATE REQUIREMENTS
Check to verify that your district established and will continue to meet all of the requirements for implementation of 4K.
YesNoRequirement
1.The 4K program is open and accessible to all age-eligible children of the district at no charge.
2.The 4K program provides a minimum of 437 hours of instruction per school year.
3.ALL 4K teachers hold a license issued by the DPI to teach prekindergarten or kindergarten.
4.The 4K program meets the school district standards under s. 121.02(2)(a), (b), (c), (e), (f), (g), (h), (i), (j), (k), (L), (o), (q), and (t), Wis. Stats.
5.The school district provides transportation to and from the 4K program at no charge as per s. 121.54(1) and (2), Wis. Stats. Briefly describe:
V. 2017-18 VERIFICATION THAT DISTRICT IMPLEMENTED COMMUNITY APPROACHES
1.Your application was approved under the community approaches priority. Your application provided details on how you would implement the community approach requirements.
Check to verify that you are implementing all of the community approach requirements in the grant application. Check all that apply.
District covered full cost of 4K program in community setting
District implemented mechanism for supervision of community site
District established and maintained a collaborative council that fulfilled the requirement
2.Children Served
a. Number of 4K children reported in 2017 child count / b. Number of 4K children served in community setting in 2017-18
3.Verify Use of Community Approaches and list names and addresses of all community partners.
a. Number of Total Sites / b. Number of Community Partners / c. Number of Community Sites
Name of Community Site / Address Street, City, State, ZIP

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V. 2010-2011 VERIFICATION THAT DISTRICT IMPLEMENTED COMMUNITY APPROACHES (Cont’d.)
Name of Community Site / Address Street, City, State, ZIP

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VI. 2018-19 DISTRICT INTENTIONTO CONTINUE COMMUNITY APPROACHES

Your application was approved under the community approaches priority. Your application provided details on how you would implement the community approach requirements. Indicate any substantial changes intended for your community approach in 2018-19.

No change to financial arrangements, supervision, or council.
Change in financial arrangements. Describe change and how it still fulfills requirements.
Change in mechanism for supervision of community site. Describe change and how it still fulfills requirements.
Change in maintaining a collaborative approach.Describe change and how it still fulfills requirements.
2.Children Served
a. Number of 4K children anticipated for enrollment for 2018-19. / b. Number of children anticipated to be served in community setting in 2018-19.
3.Verify Use of Community approaches listing any additions or deletions of community partners.
a. Number of Total Sites Anticipated / b. Number of Community Partners Anticipated / c. Number of Community Sites Anticipated
Name of Community Site / Address Street, City, State, ZIP

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VI. 2011-2012 DISTRICT INTENTION TO CONTINUE COMMUNITY APPROACHES (Cont’d.)
Name of Community Site / Address Street, City, State, ZIP