School Improvement Grant

Cohort 4, Planning Year

2017–18

Renewal Application

Renewal Applications must be received by the

California Department of Education

no later than 4 p.m. on May 26, 2017

School Turnaround Office

Improvement and Accountability Division

California Department of Education

1430 N Street, Suite 6208

Sacramento, CA 95814-5901

916-319-0833

April 2017


Table of Contents

Timeline...... iii

School Improvement Grant Renewal Application Process...... iv

Renewal Application Cover Sheet...... 1

Signatures and Approvals...... 2

Grant Contact Information...... 3

School Improvement GrantImplementation Readiness Self-assessment...... 4

Revised Annual Student Performance and Progress Goals...... 9

Revised SIG Form 2––Implementation Chart(s)...... 12

Revised SIG Form 3––Local Educational Agencyand School Budget(s)...... 13

Related Documents...... 14

School Improvement GrantRenewal Application Checklist...... 15

Appendix A—General Assurances...... 16

Appendix B—General Assurances, Sub-grant Conditions and Assurances, and Certifications 17

Timeline

Important Events / Date
2017–18Renewal Application posted to the California Department of Education (CDE) School Improvement Grant(SIG) Web page / April 17, 2017
2017–18Renewal Applicationsfrom local educational agencies (LEAs) due to the CDE by mail and e-mail / May 26, 2017
2017–18Renewal Applications reviewed by the CDE / May 30, 2017 to June 2, 2017
LEA Notification of Renewal Status / After July 1, 2017

Reminders:

  1. Check the name of the school district superintendent for the LEA using the database on the CDE California School Directory Web page at and update if there are changes.
  1. To obtain the National Council on Education Statistics Identification Number, the LEA can search for a school by using the following link at

School Improvement Grant Renewal Application Process

A.Renewal of Funding

The CDE will consider all of the following factors in determining whether or not the LEA’s SIG sub-grant will be renewed for the first year of full implementation in Cohort 4:

  • Progress on planning and pre-implementation activities
  • Analysis of current functioning related to structural supports necessary to successfully and fully implement the chosen intervention model
  • Results of planning and pre-implementation activities including any needs identified, the formation of new performance and progress goals, and focus areas for the next year

B.Renewal Application Submission

The 2017–18Renewal Application is due on or before May 26, 2017.

Applicants must submit:

  • One printed original application; and
  • One electronic copy of the application in Microsoft Word 2013 or later

Both the printedand electronic copies should besingle-spaced in 12 point Arial font using one inch margins. Implementation charts and budgets must be formatted in Microsoft Excel 2013 or later. Both the printed original and the electronic copy must bereceived by the School Turnaround Office on or before (not postmarked by) 4 p.m., May 26, 2017.Applicants must submit theelectronic copy to . Mailed documents should be sent to the following address:

School Turnaround Office

Improvement and Accountability Division

California Department of Education

1430 N Street, Suite 6208

Sacramento, CA 95814-5901

To comply with federal Americans with Disabilities Act regulations, please adhere to the following guidelines:

  • Submit text-based documents only (no scanned images).
  • If images are included, also include alternative text for that image.
  • Do not use color to convey information.
  • Do not include images of handwritten signatures for privacy reasons.

C.Grant Awards and Payments

Under the provisions of the SIG authorized under Section 1003(g) of Title I of the Elementary and Secondary Education Act of 1965, as amended (Federal Register, volume 80, p.7248,February 9, 2015), the SIG program is a five-year grant awarded in five one-year increments. For fiscal year (FY) 2017–18 grant award renewals that are approved by the CDE, the grant period is July 1, 2017, through September 30, 2018.

Grant payments are subject to fulfillment of all reporting requirements.

Additional program and fiscal information related to the SIG program can be found on the CDE SIG Web page at

1

Renewal Application Cover Sheet

School Improvement Grant

2017–18Renewal Application

RENEWAL APPLICATION RECEIPT DEADLINE

4 p.m.May 26, 2017

Paper Submission:
School Turnaround Office
Improvement and Accountability Division
California Department of Education
1430 N Street, Suite 6208
Sacramento, CA 95814-5901
Electronic Submission:

NOTE: Please print or typeinformation.

County Name / County/District Code
Local Educational Agency (LEA) Name / LEA National Council on Education Statistics Number
LEA Address / FY 2017–18 Grant Amount
City / Zip Code
Name of Primary Grant Contact / Grant Contact Title
Telephone Number / Fax Number / E-mail Address
CERTIFICATION/ASSURANCE SECTION:As the duly authorized representative of the applicant, I have read all assurances, certifications, terms, and conditions associated with the federal School Improvement Grant (SIG) program; and I agree to comply with all requirements as a condition of funding.
I certify that all applicable state and federal rules and regulations will be observed and that, to the best of my knowledge, the information contained in this application is correct and complete.
Name of Superintendent or Designee / Telephone Number
Superintendent or Designee Signature (Blue Ink) / Date

1

Signatures and Approvals

School District Approval: The superintendent, or designee, at each school district involved in the 2017–18Renewal Application must sign.
School District Name / Name of Superintendent, or Designee / Signature of Superintendent, or Designee
School Principal Approval: The principal of each school site involved in the 2017–18Renewal Application must sign.
School Name / Intervention Model / Printed Name of Principal / Signature of Principal

1

Grant Contact Information

Name of Primary Grant Contact
Title
Address
City, State, Zip
Phone Number
Fax Number
E-mail Address
Name of Fiscal Contact
Title
Address
City, State, Zip
Phone Number
Fax Number
E-mail Address

1

School Improvement Grant

Implementation Readiness Self-assessment

Instructions:A representative from theLEA, school, and other relevant stakeholders such as Lead Partner or Educational Management Organization (EMO) should collaboratively determine the status of each of the following four elements (pp.5–9), the successes and challenges encountered, reasons for any delays and the completion timeline (if applicable). A separate SIG Implementation Readiness Self-assessment must be completed for each SIG school.
LEA:______
School:______
Name/title of persons contributing to the self-assessment:
______
______
______
______
______
______
______
______
______
______
______
______
______

School Improvement Grant

Implementation Readiness Self-assessment (Cont.)

Element1 / Create and implement systemsof data collection and analysis at the school and LEA levelsto identify trends that can be used to inform decisions regardingimplementation, as well as student performance and progress.
Select the status that best describes the progress made on this element.
Not Started / In Progress / Completed
Please describe any successes and challenges in the completion of this element. If thiselement is “Not Started” or “In Progress,” please provide a timeline for completion and reason for the delay. Limit your response to 500 words or fewer.

School Improvement Grant

Implementation Readiness Self-assessment (Cont.)

Element 2 / Complete all planning and pre-implementation activities that are identified in the SIGimplementation chart (SIG Form 2a–Planning).
Select the status that best describes the progress made on this element.
Not Started / In Progress / Completed
Please describe any successes and challenges in the completion of this element. If this element is “Not Started” or “In Progress,”please provide a timeline for completion and reason for the delay. Limit your response to 500 words or fewer.

School Improvement Grant

Implementation Readiness Self-assessment (Cont.)

Element 3 / Identify needsas a result of planning year activities and revise goals, implementation charts, and/or budgetsto support identified needs.
Select the status that best describes the progress made on this element.
Not Started / In Progress / Completed
Please describe any successes and challenges in the completion of this element. If this element is “Not Started” or “In Progress,”please provide a timeline for completion and reason for the delay. Limit your response to 500 words or fewer.

School Improvement Grant

Implementation Readiness Self-assessment (Cont.)

Element 4 / Identify and secure needed resources and supports in order to ensure performance and progress in full implementation years.
Select the status that best describes the progress made on this element.
Not Started / In Progress / Completed
Please describe any successes and challenges in the completion of this element. If this element is “Not Started” or “In Progress,”please provide a timeline for completion and reason for the delay. Limit your response to 500 words or fewer.

1

Revised Annual Student Performance and Progress Goals

Each participating LEA must establish clear, measurable, and challenging goals for student performance and progress on the state’s assessments in both reading/English language arts and mathematics for each of the identified schools the LEA commits to serve. The LEAs must use the goals to monitor the progress of each school that receives SIG funds. Renewal of each LEA’s SIG, with respect to a particular school, is subject to each school’s progress made toward meeting the annual goals for student performance and progress.

Instructions:

Revise the student performance and progress goals for each SIG school based on progress made and needs identified during the planning year. For each identified need, complete one table. Include as many needs and goals for each school as applicable. Add additional tables and expand as necessary.

1

Revised Annual Student Performance and Progress Goals:

Reading/English Language Arts

Identified Need(s) :
Goal(s) Applies to: / School:
Schoolwide; Grade Level and/or Student Groups:
School Improvement GrantEstablishedAnnual Measurable Goal(s)for Full Implementation
Full Implementation Year 1
Full Implementation Year 2
Full Implementation Year 3
Full Implementation Year 4
Full Implementation Year 5, if applicable

Revised Annual Student Performance and Progress Goals:

Mathematics

Identified Need(s) :
Goal(s) Applies to: / School:
Schoolwide; Grade Level and/or Student Groups:
School Improvement GrantEstablished Annual Measurable Goal(s)for Full Implementation
Full Implementation Year 1
Full Implementation Year 2
Full Implementation Year 3
Full Implementation Year 4
Full Implementation Year 5, if applicable

1

SIG Form 2––Revised Implementation Chart(s)

The LEA must revise and include the revisedSIG Form 2––Implementation Chart for each SIG school reflecting all activities completed in the planning year,and all activities proposed for full implementation.Please highlight all revisions.

The Implementation Chart must include the following:

  • Proposed revisions identified in the Program Evaluation of SIG Required Components
  • Specific action steps completed and projected for all required components of the model
  • The timeline to complete each action step, including beginning and ending implementation dates, using both month and year designations for actions to be completed in each school year of the grant period
  • Person(s) responsible for ensuring that each action step is completed according to the timeline
  • Documentation of evidence submitted to the CDE, upon request, to verify implementation of action steps

Attacha printed copy of the revisedSIG Form 2––Implementation Chart for each SIG school.Also, includethe electronic copy of the revised Implementation Chart in Microsoft Excel 2013, or later, with the electronic version of this application. Ensure that all text within the spreadsheet cells is visible in the printed and electronic versions.

The LEA and school SIG Form 2––Implementation Chart forms are located on the CDE SIG Cohort 4 Request for Applications Web page at

1

SIG Form 3––Revised Local Educational Agencyand School Budget(s)

The LEA must include the revised budget(s) for the LEA and for each SIG school reflecting all proposed expenditures for each year of the grant.

  • Ensure that all text within the spreadsheet cells is visible in the printed and electronic versions. Budget expenditures should align with activities outlined in the Implementation Charts.
  • Please note that each budget should cover all years of implementation and be of sufficient size and scope to implement the selected school intervention model in each school that the LEA commits to serve.

Attach a printed copy of the LEA budget and a school budget for each identified SIG school.Include the electronic copy of these budgets in Microsoft Excel 2013, or later, with the electronic version of this application.

The SIG Form 3––LEA and School Budget(s) forms are located on the CDE SIG Cohort 4 Request for Applications Web page at

1

Related Documents

Partner Agreements:Include a printed copy of the following applicableagreements established during the planning year:

  • Agreement with Lead Partner for schools implementing the State-determined Intervention Model (CA SDIM);and/or
  • Agreement with the EMO for schools implementing the Restart Model or
    CA SDIM

Financial Activity Reports:Include a printed copy offinancial activity reports to date of the working budget for Resource Code 3180 that includes major and minor sub-object codes, sorted by resource and object code, and totals for each major object code.

1

School Improvement Grant

Renewal Application Checklist

Required Documents

The following documents must be included as part of the2017–18Renewal Application. Check or initial by each document, and include this form in the application package. These forms can be downloaded from the CDE SIGCohort 4 Web page at Please compile the application packet in the order provided below and include the completed checklist in the application packet.

______Renewal Application Cover Sheet
(Must be signed in blue ink by the LEA superintendent or designee)

______Signatures and Approvals

______Grant Contact Information

______School Improvement GrantImplementation Readiness Self-assessment

______Revised Annual Student Performance and ProgressGoals:Reading/English Language Arts

______Revised Annual Student Performance and ProgressGoals: Mathematics

______Revised SIG Form 2––Implementation Chart(s)

______Revised SIG Form 3––Local Educational Agencyand School Budget(s)

______Partner Agreements

______Financial Activity Reports

1

Appendix A—General Assurances

Note: All sub-grantees are required to retain a copy of these assurances on file for their records and for audit purposes. Please download the 2016–2017General Assurances form located on the CDE Funding Tools and Materials Web page at Do not submit Appendix A to the CDE; retain at the LEA.

Download the following three certifications from the CDE Funding Tools and Materials

Web page at The signature on the front of the application indicates acknowledgement of an agreement with allassurances. (Do not submit as part of the application.)

  1. Drug Free Workplace
  2. Lobbying
  3. Debarment and Suspension

1

Appendix B—General Assurances, Sub-grant Conditions and Assurances, and Certifications

Sub-grant Conditions and Assurances

As a condition of the receipt of funds under this sub-grant program, the applicant agrees to comply with the following Sub-grant Conditions and Assurances.

The U.S. Department of Education requires LEAs to adhere to the following assurances:

  1. Use its SIG to fully and effectively implement an intervention in each Tier I and Tier II school that the LEA commits to serve, consistent with the FY 2014 SIG final requirements.
  1. Establish annual goals for student achievement on the state’s assessments in both reading/English language arts and mathematics and measure progress on the leading indicators in Section III of the FY 2014 SIG final requirements in order to monitor each Tier I and Tier II school that it serves with school improvement funds; and establish goals, approved by the state educational agency (SEA), to hold accountable its Tier III schools that receive school improvement funds.
  1. Include, in its contract or agreement with the LEA, terms and provisions to hold the Charter School Operator, Charter Management Organization, or EMOaccountable for complying with the FY 2014 SIG final requirements, if implementing a Restart Model in a Tier I or Tier II school.
  1. Monitor and evaluate the actions an LEA has taken, as outlined in its approved SIG application, to recruit, select, and provide oversight to external service providers to ensure their quality, and regularly review and hold accountable such providers for their performance.
  1. Monitor and evaluate the actions schools have taken, as outlined in the approved SIG application, to sustain the implemented reforms after the funding period ends, and ensure that it will provide technical assistance to schools on how they can sustain progress in the absence of SIG funding.
  1. Report the school-level data required under Section III of the FY 2014 SIG final requirements to the SEA, including baseline data for the year prior to SIG implementation (this may include other data requested by the CDE).

Appendix B—General Assurances, Sub-grant Conditions and Assurances, and Certifications

(Page 2 of 3)

  1. Ensure that each Tier I and Tier II school the LEA commits to serve receives all of the state and local funds it would receive in the absence of the school improvement funds, and that those resources are aligned with the established interventions.

Furthermore, the CDE requires LEAs to adhere to the following additional assurances:

  1. In implementing the California State-determined Intervention Model, the LEA must ensure that during the planning year it will identify and select one of the required Lead Partners and maintain the partnership throughout the grant period.
  1. Ensure that the identified strategies and related activities are incorporated in the revised LEA Plan and Single Plan for Student Achievement.
  1. Follow all fiscal reporting and auditing standards required by the CDE.
  1. Participate in a statewide evaluation process as determined by the SEA and provide all required information in a timely manner.
  1. Respond to any additional surveys or other methods of data collection that may be required for the full sub-grant period.
  1. Use funds only for allowable costs during the sub-grant period.
  1. Include in the application all required forms signed by the LEA Superintendent or designee.
  1. Use fiscal control and fund accountability procedures to ensure proper disbursement of, and accounting for, federal funds paid under the sub-grant, including the use of the federal funds to supplement and not supplant state and local funds, and maintenance of effort (20 United States Code § 8891).
  1. Hereby express its full understanding that not meeting all SIG requirements will result in the termination of SIG funding.
  1. Ensure that funds are spent as indicated in the sub-grant proposal and agree that funds will be used only in the school(s) identified in the LEA’s AO-400 Sub-Grant Award Letter.

Appendix B—General Assurances, Sub-grant Conditions and Assurances, and Certifications