Attachment A, Memo No.239-11

August 26, 2011

Virginia Department of Education

Office of School Nutrition Programs

Grant Application for National School Lunch Program Equipment

PART I.GENERAL INFORMATION,CERTIFCATION, SIGNATURES,

AND EVALUATION CRITERIA

AA

A. APPLICANT INFORMATION
SCHOOL DIVISION NAME: / Division No.
Superintendent’s Name:
E-Mail: / Telephone:
School Nutrition Director/Contact Name:
E-Mail: / Telephone:
B. APPLICATION FOR PROGRAM FUNDING
Fund Code / Program Name / Project Duration / Total Grant Amount Requested
CFDA No. 10.579 / Virginia Department of Education,
National School Lunch Program (NSLP) Equipment Assistance Grant / Upon Approval / 8/1/2012
C. CERTIFICATION
I certify that the information contained in this application is correct and complete; that the applicant school division has authorized me, as its representative, to file this application; and that I understand that for any funds received through this application the school division agrees to comply with all applicable state and federal grant requirements and any instructions or procedurescovering both the programmatic and fiscal administration of grant funds.
Typed Name of Division Superintendent / Typed Name of School Nutrition Director/Contact
Signature of Division Superintendent / Signature of School Nutrition Director/Contact
Date: / Date:
DATE DUE: Monday September 19, 2011
Proposals must be received at the Department by 5 p.m. on the date due.
Mail the proposals listed on this signaturepage to:
Virginia Departmentof Education
Office of School Nutrition Programs
Attn: Catherine Digilio Grimes (21st floor)
P.O. Box 2120
Richmond, Virginia 23218-2120

Number of sets: Submit two (2) sets, each with an original signature of the Division

Superintendentand the School Nutrition Director.

D. Evaluation CriteriaMaximum score - 100 points
Points
1. / FREE AND REDUCED-PRICE ELIGIBILITY (school level): / Actual value
Points will be equal to the school’s Free and Reduced Price Student Eligibility percentage as of October 2010. Only school sites with eligibility of 50% or higher will be considered. / (50-100)
2. / FOCUS AREA DESCRIPTION:
Narrative on the school applications that describes how the equipment requested will address one or more of the following focus areas (higher considerationwill be awarded for multiple focus areas being utilized by equipment requested): / YES / NO
  1. Equipment that allows the SFA to support and sustain expanded participation in a school nutrition program.

  1. Equipment that lends itself to improving the quality of school food service meals.

  1. Equipment that improves the safety of food served in the NSLP.

  1. Equipment that improves overall energy efficiency of the food service operation.

3. / BUDGET: / YES / NO
Budget detail provided for each item that is complete and reasonable.
4. / OTHER:
Other consideration will be given to school division ability to meet deadlines and the cash operating balance of the school nutrition programs.

PART II: SCHOOL DIVISION LEVEL DATA AND BUDGET SUMMARY

Please complete only one (1) budget form (two pages in length) for the entire grant request

SCHOOL DIVISION NAME:
1. / Is the dollar value your school division uses for reporting equipment as an asset in the financial statement and inventory system $5,000.00? / YES / NO
If NO what is the amount (capitalization threshold)? / $
2. / Total amount of grant funds requested for all school sites.
(taken from division grand total below) / $
3. / Grant requests may not be fully funded. Would you accept partial funding? / YES / NO
If YES, you may be contacted for more information.
4. / Provide a very brief description justifying the need for the equipment requested:
Enter the Total Dollar Amount Requested for each School Site and the Grant Total
(Enter A Priority Number For Each Site)
SCHOOL No. / SCHOOL NAME / TOTAL
Amount Requested / PRIORITY #
1
2
4
5
6
7
8
DIVISION GRAND TOTAL / $

PART III: SCHOOL LEVEL INFORMATION/ GRANT PROPOSAL

Instructions:

  1. Complete one copy of this form for each school within the school division applying for a School Nutrition Equipment Assistance Grant.
  2. No more than three (3) pieces of equipment may be requested for each school site.
  3. Include copies of supporting documentation forprices of each piece of equipment requested for funding. If supporting documentation is not included with each school level application, then the equipment request for that school will not be considered.

Return thesesigned application(s)along with the completed signature and budget pages no later thanSeptember 19, 2011.

SCHOOL INFORMATION:
School Division:
School Name: / SNP Unit Number:
School Address:
PROPOSAL:
Describe briefly the equipment requested and how the school plans to address any or all of the following focus areas.(If requesting the purchase of more than one piece of equipment, please attach additional proposal information as needed)
Describe the piece of equipment requested and describe all associated costs (i.e., delivery, installation, removal, etc). (Please note: a piece of equipment must have an acquisition cost of $5,000 or more):
Amount requested for the piece of equipment:
1. How will the equipment allow the school to support and sustain expanded participation in a school nutrition program (e.g., equipment for serving meals in a nontraditional setting or to better utilize cafeteria space)?
2. How will the equipment lend itself to improving the quality of school meals that meet Dietary Guidelines for Americans (e.g., purchasing an equipment alternative to a deep fryer)?
3. How will the equipment improve the safety of the food served in the school nutrition programs?
4. How will the equipment improve overall energy efficiency?
SITE APPLICATION SIGNATURE SECTION
Typed Name of School Nutrition Director/Contact
Signature of School Nutrition Director/Contact / Date:

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