Title I Part D, Subpart 1, Section 2 – Institution

July, 2016 Page 1 of 6

Institution Name

TITLE I PART D, SUBPART 1, SECTION 2

ESEA 2016-2019

INSTITUTION LEVEL APPLICATION
  1. Program Goals, Measurable Objectives and Assessments - Updates required as needed each year of the funding cycle.

Subject/Program Area / Long Term Goal
By end of 2019 SY / What overall changes in academic and vocationalabilitiesdo you expect your students to achieve within the 2015-2016 SY? / What assessments that will be used to assess these goals?
Include pre/post dates for reading and math assessments. / Who is responsible for giving and analyzing student results
Academic Outcomes
Mathematics
Reading
Vocational Outcomes

Title I Part D, Subpart 1, Section 2 – Institution

July, 2016 Page 1 of 6

Institution Name

2. Scope of Project

  1. Students to Be Served

Using current data as a basis, estimate the number of students who will participate in the Title I

Part D, Subpart 1 program’s instructional and support related components each SY year 2016-2019. These numbers can be updated as part of subsequent program renewals.

Ages /

Reading

/

Mathematics

5 – 10 years old
11 – 15 years old
16 – 18 years old
19+ years old
  1. Staff Paid with Title I, Part D, Subpart 1 Funds

Using the chart below describe the staffto be paid with these funds.

Number

/ FTE
(fulltime equivalent) / Responsibility/Job Title / Certification or other Qualification Required for Position / Each Estimated Salary
  1. Transition Coordinator

Designate an individual or individuals to be responsible for issues relating to the transition of children and youth from the institution to locally operated programs.

Name of IndividualTitle of Individual

Name of IndividualTitle of Individual

  1. Staff/Student Ratio’s:

Total students provided T1 D supportdivided by Total T1 Dstaff FTE =to 1

Institution Name

  1. Program Description: (Use additional space as needed)

1)Describe the program in sufficient detail such that a teacher implementing this project and/or parents/guardians or persons visiting would know what to expect.

2) Describe function of major personnel such as home/school coordinators. (Attached job descriptions are appreciated)

3)Describe any additional services, beyond instruction, for children and youth provided with these funds such as career counseling, etc.

  1. Transition Services:

1)Identify (by dollar amount) the financial reserves (must be between 15-30 percent of allocated funds) which will be used to provide transitional education services for neglected or delinquent children and youth. It is required to set-aside a minimum of 15% and a maximum of 30% (each program year) of your dollars for this purpose.

2)Describe how the above reserved funds will be used for transitional educational services (i.e. to re-enter school successfully or preparation for employment).

Institution Name

  1. Professional Development:

1)List the major NEEDS of the Title I staff and institution staff relating to the objectives of the Title I project that can be met by in-service training programs.

2)Describe all staff development activities to be funded by this grant. PD activities for 2016-2017 only. Activities will be updated each year with the budget summary. (How many hours of training, when, for whom, and what topics will be covered?) Include a timeline.

H.Coordination:

Describe how the program/s will be coordinated with other appropriate State and Federal programs, such as Vocational Education, Special Education, Work Force Investment Act and local dropout prevention programs. If applicable grade levels, describe how the institution will endeavor to coordinate with local businesses for training and mentoring opportunities for participating youth.

Title I Part D, Subpart 1, Section 2 – Institution

July, 2016 Page 1 of 6

Institution Name

I.Budget Narrative

Use this form to provide sufficient detail regarding proposed expenditures of Title I Part D, Subpart 1 funds for 2016-2017. Requires updated budget narrative for each year of the funding cycle.

Account Category / Budget Detail / Total Costs
Salaries and Benefits
Include title and number of employees. Include rate of pay by hour/week etc.
Contracted Services
Summarize activities and provide breakdown of expenses.
Supplies and Materials
Detail purchases (ex. #@$). Explain the connection between items and the activities in the application.
Books
Detail purchases (ex. #@&). Explain the connection between purchases and the activities in the application.
Equipment
Attach a justification for each item to be purchased.
Professional Development Activities
Travel
Summarize activities including the number of days, people involved and associated costs.
Administration
Total Costs