1 | Page 807 21st Century Community Learning Center - Cohort 14 Fiscal Year: 17-18 Milestone: Under OSPI Review (Printed 7/28/2017) District: Burlington-Edison School District Organization Code: 29100 ESD: Northwest Educational Service District 189 Page 1 READ THIS FIRST! 21st Century GAP *Section 5, Proposal Narrative Amended (28 pages maximum) Title I Eligible Schools - Only Title I Eligible and Title I Serving schools are eligible to apply. 2017-2018 Eligible Entity Partnership and Compliance with Program Assurances Determination of Eligible Entity Partnership An eligible entity partnership is a requirement for consideration for funding. The partnership must include a school district(s) or Local Education Agency (LEA) with designated high poverty schools that are Title I eligible, and at least one community-based organization, that is not primarily a contracted service provider. For the purpose of this grant an Educational Service District (ESD) is considered an LEA, and a partnership between an ESD and a school district, or two or more school districts would not be considered an eligible entity partnership, without the inclusion of a community based organization as a primary partner. Community-based organizations can include other public and non-profit agencies and organizations, businesses, educational entities (such as vocational and
Transcript
1 | P a g e
807 21st Century Community Learning Center - Cohort 14 Fiscal Year: 17-18 Milestone: Under OSPI Review (Printed 7/28/2017) District: Burlington-Edison School District Organization Code: 29100 ESD: Northwest Educational Service District 189
Page 1
READ THIS FIRST! 21st Century GAP *Section 5, Proposal Narrative Amended (28 pages maximum) Title I Eligible Schools - Only Title I Eligible and Title I Serving schools are eligible to apply.
2017-2018 Eligible Entity Partnership and Compliance with Program Assurances
Determination of Eligible Entity Partnership An eligible entity partnership is a requirement for consideration for funding. The partnership must include a school district(s) or Local Education Agency (LEA) with designated high poverty schools that are Title I eligible, and at least one community-based organization, that is not primarily a contracted service provider. For the purpose of this grant an Educational Service District (ESD) is considered an LEA, and a partnership between an ESD and a school district, or two or more school districts would not be considered an eligible entity partnership, without the inclusion of a community based organization as a primary partner. Community-based organizations can include other public and non-profit agencies and organizations, businesses, educational entities (such as vocational and
adult education programs, school-to-work programs, faith-based organizations, community colleges or universities), recreational, cultural and community service entities. Proposals must be jointly submitted by school districts and community-based organizations or other private or public entities. Only 1 application per school district is allowed in a single grant cycle. (Some rural remote schools may be exempt from the partnership requirement, upon request, and the provision of evidence that this requirement cannot be met within reasonable geographic proximity, and would prevent them from applying for this program funding.)
Press the "NEW" button to complete information for each new record. To avoid losing data, press the "SAVE" button after completion of each new record. Allow save to complete before pressing the "NEW" button again.
Instructions: REQUIRED In the space below there must be a minimum signature of 1 Superintendent and 1 Community Based Organization CEO, or representative. Print the signature page, sign it, and upload as an attachment on page 5.
Name of Primary Partner Representative: (District Superintendent or Chief Executive Officer)
Laurel Browning
Title of Authorizing Primary Partner Representative: District Superintendent
Name of Organization or School District: Burlington-Edison School District
Press the "NEW" button to complete information for each additional Partner. To avoid losing data, press the "SAVE" button after completion of each new Partner. Allow save to complete before pressing the "NEW" button again.
In the space below provide any additional partners that will be making contributions to this proposed grant project.
Name of Partner Representative: (District Superintendent or Chief Executive Officer)
Erika McPhee-Shaw
Title of Authorizing Partner Representative: Director, Professor, Shannon Point Marine Center
Name of Organization or School District: Western Washington University
1. The partnership includes at least one Local Education Agency (LEA) or school district (with only designated high poverty, Title I eligible schools) and at least one community-based organization, that is not primarily an entity contracted to provide services to the project. A partnership is an entity with the primary partners making significant contributions to the grant goals and outcomes, providing either direct financial support or in-kind support, which is documented in the budget narrative.
2. The school district administration and at least one community based organization collaborated extensively in the planning and design of the program.
6 | P a g e
3. Each partner organization has substantial roles to play in the implementation of the program; delivery of services, program evaluation, and program improvement plans over the duration of the project.
4. All partner organizations share program resources to carry out their roles, and contributions are reflected in the budget Narrative as in kind or direct support.
5. All partners have significant and ongoing involvement in the management and oversight of the program.
6. A formal Memorandum of Agreement among the partners and the fiscal agent has been signed that specifically states that the fiscal agent cannot act as ‘flow-through’ for grant funds and does not subgrant to other recipients. For example, applicants are not permitted to subgrant a significant portion of their award to a single entity.
7. The Memorandum of Agreement also identifies all partner obligations and contributions for cash, direct service, or in-kind, as well as roles and responsibilities for oversight supervision and management of the project.
8. Priority for funding will be given to partnerships that provide evidence of collective planning, implementation, evaluation, and planning for sustainability.
7 | P a g e
9. Applications submitted without evidence of an eligible entity partnership, a formal Memorandum of Agreement, and/or a formal Data Sharing Agreement will not be considered for funding.
To be considered as a viable eligible entity partnership, there must be evidence that: Compliance with Program Regulations
I certify that to the best of my knowledge and belief, information provided in this application is true and correct, the document has been duly authorized by the governing bodies of the eligible entity partnership applicants, and the applicants agree to comply with the attached assurances and general assurances under the Elementary and Secondary Education Act (ESEA), as amended by the Every Student Succeeds Act (ESSA) of 2015; and the terms of the proposal if the proposal is approved for a grant award. Before completing this certification, please read assurances carefully. By signing the Certificate of Assurances, the duly authorized representatives of the eligible entity partnership certify that the partnership will comply with the assurances pertinent to all applicants and to programs for which the applicant is applying, including but not limited to: Compliance with all federal requirements of the federal 21st Century Community Learning Centers as detailed in Title IV, Part B of the Elementary and Secondary Education (ESEA) Act of 2001, as amended by the Every Student Succeeds Act (ESSA) of 2015 and general provisions. The applicant assures to the best of his/her knowledge and belief that the data in this application are true and correct and that the filing of the application has been duly authorized by the governing board of the applicant and that the applicant will comply with the required assurances if funding is approved. Projects are required to sign the Certificate of Assurances, certifying that the applicant will comply with the assurances pertinent to all applicants and to programs for which the applicant is applying. The applicant also certifies that they will comply with the general assurances listed in the consolidated state application (iGrants).
1. An assurance that the program will take place in a safe and easily accessible facility.
8 | P a g e
2. An assurance that the proposed program was developed, and will be carried out; in active collaboration with the schools that participating schools attend (including through the sharing of relevant data among the schools), all participants of the eligible entity, and any partnership entities described in subparagraph (H), in compliance with applicable laws relating to privacy and confidentiality, and in alignment with the challenging State academic standards and any local academic standards.
3. An assurance that there will be no barriers to participation by qualifying students.
4. An assurance that the program will primarily target students who attend schools eligible for schoolwide programs under Section 1114 of the ESEA and the families of such students. Enroll students who may be at risk for academic failure; dropping out of school, involvement in criminal or delinquent activities, or who lack strong positive role models, and the families of students described in section 1116.
5. An assurance that funds under this part will be used to increase the level of state, local, and other non-federal funds that would, in the absence of funds under this part, be made available for programs and activities authorized under this part, and in no case supplant federal, state, local, or non-federal funds.
6. An assurance that the applicant has sought out public comment on the 21st Century Community Learning Center grant proposal before submission, especially from those parents whose children are proposed to be served by the program, and has considered such comments in the development of the application.
9 | P a g e
7. An assurance that staff time paid through the 21st Century Community Learning Centers funding is fully dedicated to the 21st Century Community Learning Center.
8. The applicant will comply with all federal and state statutes and administrative regulations and all program plans and applications, which are applicable to this program.
9. The applicant will use fiscal control and fund accounting procedures that will ensure proper disbursement of, and accounting for, federal funds paid to the applicant under the program and in the event of an audit exception, shall repay federal funds upon completion of audit resolution.
10. The applicant agrees to adopt and use proper methods of administering this program, including but not limited to: (1) the enforcement of any obligations imposed by federal statutes and administrative rules on the applicant responsible for carrying out this program and (2) correcting any deficiencies in program operations that are identified through audits, monitoring, or evaluation.
11. The applicant agrees to provide all information as directed or as requested by the Office of the Superintendent of Public Instruction, the Secretary for the U.S. Department of Education, and other federal officials for audit, program evaluation, compliance, monitoring, and other purposes; and to maintain all records for the current year.
10 | P a g e
12. The applicant certifies that no funds have been paid to any person to influence an officer or employee of any federal or state department or agency.
13. The applicant agrees to provide all student data required for state and federal reporting. (If non-profit or faith-based agency a data sharing agreement has been developed.)
14. The applicant agrees to participate in any quality program assessment required by OSPI.
15. The applicant will provide a current signed data-sharing agreement between all partners in the appendices that will be implemented between the school districts and agencies providing service to ensure that pertinent student specific data, academic records, student achievement results, and student surveys are collected, shared, and accurately submitted to the federal data reporting system in a timely manner. Data sharing is an integral and required element of effective program partnerships.
21st Century Community Learning program grants are awarded on a competitive basis after thorough review by a committee, with funding based on need as well as quality of proposal. I understand that any proposal selected for funding is to be implemented as written in the original proposal. If substantial programmatic changes which result in altering the intent of the originally funded proposal are made during the course of the grant period, funds may be withheld. All requests for program changes must be formally approved by OSPI.
Page 2
11 | P a g e
Program Profile Grantee Name: Lucille Umbarger Elementary School Grant Request Amount: $264,522
What school districts will be served by this project? Burlington-Edison
If you were a previously funded project, what year was the grant awarded? N/A
What priorities for funding does this grant application propose to meet and has demonstrated evidence in the program proposal?
A. Schools Proposing to serve:
1. Highest levels of poverty, 80% or more based off the Free and Reduced-price lunch eligibility.
2. Highest percentage of students not meeting proficiently in literacy and mathematics. 3. Title 1 Participating School. 4. Identified as a Priority or Focus School. 5. Applications that target populations of students and families with a high percentage
of racial and ethnic minorities (more than 80%) including; Hispanic/Latino, American Indian/Alaskan Native, Asian, Black/African American, Native Hawaiian/ Other Pacific Islander, and Two or More Races.
6. Evidence of an unmet need for out of school time services in the community.
B. Program Activities that:
1. Provide after-school activities for students who are English Learners that emphasize language skills and academic achievement.
12 | P a g e
2. Partner with in-demand fields of the local workforce or build career competencies and career readiness and ensure that local workforce and career readiness skills are aligned with the Carl d. Perkins Career and Technical Education Act of 2006 (20 U.S.C. 2301 et seq.) and the Workforce Innovation and Opportunity act (29 U.S.S. 3101 et. Seq.).
3. Provide literacy education programs, including financial literacy programs and environmental literacy programs.
4. Build skills in science, technology, engineering, and mathematics, (STEM) including computer science, and that foster innovation in learning by supporting nontraditional STEM education teaching methods.
Evidence of funding priorities for specific populations and activities must be clearly demonstrated in the Profile Page, The Narrative, Need Statement, and Quality of Project Design Sections.
Regular School Year Program
Programs are required to be operational September through the end of the school district calendar. What months will your school year program be in operation? September-June WHAT ARE THE PARAMETERS OF YOUR REGULAR SCHOOL YEAR PROGRAM? Press the "NEW" button to complete a record for each site.
To avoid losing data, press the "SAVE" button after completion of each new record. Allow SAVE to complete before pressing the "NEW" button again.
Site Profile
13 | P a g e
Site Name? Lucille Umbarger Elementary School School Based? Yes Community Based Center? No Address where services are provided: 820 S SKAGIT ST BURLINGTON, WA 98233-2499 Name of School Building(s) served: Lucille Umbarger Elementary School Building Address: 820 S SKAGIT ST BURLINGTON, WA 98233-2499 School District Address: 927 E Fairhaven Ave, Burlington, WA 98233 Building Code(s): 3251
Student Services School Year
Hours/Day
Hours/Week
Weeks/Year
Grades
Served
Number
Enrolled in 21st CCLC
Average Daily
Attendance
Students
Served 30
Days or More
Students
Served 60
Days or More
Previous 21st CCLC
Funding?
Title I School Serving? (For OSPI Use
Only)
% Free and
Reduced
Lunch (For OSPI Use
Only)
14 | P a g e
3.0 12.0 32.0 6-8 120 80 90 75 No Yes 67%
Percentage of Students Not Proficient in Reading and Math (relevant to the building that is associated with your site)
Summer Program Summer programs must be a MINIMUM of 4 weeks, 20 hours a week, a total of 80 hours. What months will your summer program be in operation? July WHAT ARE THE PARAMETERS OF YOUR SUMMER PROGRAM? Press the "NEW" button to complete a record for each site.
To avoid losing data, press the save button after completion of each new record. Allow save to complete before pressing the "New" button again.
Site Profile
Site Name? Lucille Umbarger Elementary School School Based? Yes Community Based Center? No Address where services are provided: 820 S SKAGIT ST, BURLINGTON, 98233-2499
16 | P a g e
Name of School Building(s) Served: Lucille Umbarger Elementary School, Bayview Elementary School, Allen Elementary School, West View Elementary School, Edison Elementary School Building Address: 820 S SKAGIT ST, BURLINGTON, 98233-2499; 15241 Josh Wilson Rd, Burlington, WA 98233; 17145 Cook Rd, Bow, WA 98232; 515 W Victoria Ave, Burlington, WA 98233; 5801 Main Ave, Bow, WA 98232 School District Address: 927 E Fairhaven Ave, Burlington, WA 98233 Building Code: 3251
Student Services Summer
Hours/Day Days/Week Weeks/Year Grades Served
Projectd Number Enrolled in 21st CCLC
Average Daily
Attendance
Students Served 20 Days or More
Adult Family
Members Served
5.0 4.0 4.0 6-8 160 140 100 20
Summary of Summer Profile(s)
Average Hours/Day
Average Days/Week
Average Weeks/Year
Grades Served
Add Projectd Number Enrolled
Average Daily
Attendance
Add Students Served 20 Days or More
Add Adult
Family Members Served
17 | P a g e
in 21st CCLC
5.0 4.0 4.0 N/A 160 140 100 20
What activities will be provided to students and families? Press the "NEW" button to complete a record for each site.
To avoid losing data, press the "SAVE" button after completion of each new record. Allow SAVE to complete before pressing the "NEW" button again.
Site Name: Lucille Umbarger Elementary School
Subject Curriculum (if known)
Literacy
Homework Club during the school year; Via Campesina "Food Sovereignty" curriculum as adapted by WWU's SEED
student-teachers (during summer)
Science
Math Standard K-12 [during Homework Club]
Art & Music
Rhymes to Re-Education: A Hip Hop Curriculum; Also, co-creation of curriculum with students and New Wilderness
Project
18 | P a g e
Cultural & Social Studies
Parents and students may lead these activities based on their heritages.
Youth Development per 4-H (WSU-Extension) Adventure Education, specifically
from the Rites of Passage program manual
Telecommunications & Technology
code.org (for middle school)
Health & Nutrition
STEM Vex Robotics (possibly using Robomatter's TREC Curriculum)
Family Engagement no curriculum but will consider the ideas of "Funds of
Knowledge"
Family Education via Community Action of Skagit County (proprietary)
ELL Curriculum via Community Action of Skagit County (proprietary)
Career and Technical Ed
19 | P a g e
Page 3
Budget Narrative
Note: The budget narrative below does not replace the official budget matrix to be completed at a later date after finalists have been notified. All Purchased Services need to be clearly delineated in the middle column. The Direct charges to the grant as well as Purchased Services will automatically be totaled for you. Therefore, totals from direct charges and purchased services should equal your total grant amount requested. The budget narrative is awarded points, and an accurate and detailed cost calculation for each budget object is required.
Cost Calculation Direct
Charges to Grant
Amount Purchased Services (name provider)
Total of Direct
Charges and
Purchased Services
Cash Value of Partner
Contributions (name partner)
Certificated/Classified Staff Allen 21st CCLC Director ($29.54/hr x 193 days) [Sept 2~Jun15] = 18 hrs/wk [0.45 FTE] Allen 21st CCLC Site Coordinator ($29.54/hr x 193 days) [Sept 2~Jun15] =32 hr/wk [0.8 FTE] Literacy & Language ($29.54/hr x 3.5 hrs/day x 124 days) - Comm. Of Practice Meetings [1.0 hrs/ wk @ 31 wks] Cultural Art Enrichment
$136,371
$ Amt: $27,000
($19000) Community Action of Skagit County
for adult services including ELL, Financial
literacy, and GED courses. ($7500) for Shannon Point Marine
Center with matching in-kind support; ($500) Motivation speakers & The New Wilderness
Project
$163,371
$ Amt: $134,869
($35269) Community
Action of Skagit County;
($63580) Western
Washington University- [SEED
program ($46080) &
$8500 Americorps contribution & Shannon Point Marine Center
($29.54/hr x 3.5 hrs/day x 124 days) - Comm. Of Practice Meetings [1.0 hrs/ wk @ 31 wks] Communications & Youth Radio ($29.54/hr x 3.5 hrs/day x 124 days) - Comm. Of Practice Meetings [1.0 hrs/ wk @ 31 wks] Math & Robotics ($29.54/hr x 3.5 hrs/day x 124 days) - Comm. Of Practice Meetings [1.0 hrs/ wk @ 31 wks] Music & Performing Arts Enrichment-- AMERICORPS ($29.54/hr x 3.5 hrs/day x 124 days) - Comm. Of Practice Meetings [1.0 hrs/ wk @ 31 wks] Community of Practice/ PD time (5 staff members x $29.54/hr x 1 hr/wk x 31 weeks) LU Collaboration time bi-monthly (5 staff members x 2 hrs/mo x 8 months x $29.54/hr SUMMER 21st CCLC Director ($29.54/hr x 24 hrs/week x 4 weeks), incl training day [split 1/2 w other grant] SUMMER 21st CCLC Site Coordinator ($29.54/hr x 24 hrs/week x 4 weeks),
($15000) Burlington Public Library staff time for programming and library visits ($5000) Skagit Valley College
work study students;
($2000) Parent volunteer time;
($9020) Americorps Volunteer;
($1500) high school student
volunteers
21 | P a g e
incl training day SUMMER SCHOOL instructors (5 instructors x $29.54/hr x 24 hrs/week x 4 weeks = 100 hours, incl 4 hrs of training)
Benefits/Payroll Taxes Director & Site Coordinator (0.5156 * salaries); Direct Service staff (0.1516 * salaries)
$43,712 $ Amt: $0
N/A
$43,712
$ Amt: $0
N/A
Supplies/Materials Miscellaneous Office supplies: staples, post-it notes, paper clips, pens, clipboard, etc. Misc School supplies: Butcher paper, notebooks, clip boards, dry erase boards, pens, pencils, magnets, etc. Communications class: 3 handheld cameras, microphones, mic stands, speakers, extension cords, interview lights, etc. Math & Robotics: VEX Curriculum, robot kits Music: Curriculum, basic instruments, audio equipment (shared with
$9,300
$ Amt: $0
N/A
$9,300
$ Amt: $2,500
Rotary Club time and money
donated to the LU Food Backpack
Program
22 | P a g e
communicaitons class), Art supplies: crayons, markers, watercolors, watercolor paper, easels, clay, etc. Garden supplies: wood for garden boxes, soil, hand tools, tool shed, hose, sprayer nozzle, etc. Improv: costume materials, audio equipment (shared with communications class) Supplies for Community Gathering/ Student Showcase Events (300/ event x2 events) - Heritage Language Club materials Professional Development Library books
Instructional Resources Included in Supples/Materials above (ie: Curricula, professional development library, etc.)
$0 $ Amt: $0
N/A
$0
$ Amt: $0
N/A
Travel Fall (Seattle) Directors/ Evaluators Meeting- Hotel ($180/ room per night) Fall (Seattle) Directors/
$4,863 $ Amt: $0
N/A
$4,863
$ Amt: $0
N/A
23 | P a g e
Evaluators Meeting- Gas ($100/ trip) Fall (Seattle) Directors/ Evaluators Meeting- Food ($47/day) YPQA (In-person) Site Coordinator Meeting- Hotel YPQA (In-person) Site Coordinator Meeting- Gas ($0.54/mile) YPQA (In-person) Site Coordinator Meeting- Food Evaluator/ Director Spring meeting (Wenatchee/Yakima) (1 night)- Hotel Evaluator/ Director Spring meeting (Wenatchee/Yakima) - Gas ($0.54/mile) Evaluator/ Director Spring meeting (Wenatchee/Yakima) - Food Hotel room for YPQI trainings (180/ night, 2 nights) and other trainings Staff fuel reimbursement for YPQI trainings ($100/ trip x 2 vehicles) Staff food reimburement for YPQI trainings ($47/ day per person)
Transportation $21,068 $ Amt: $0
$21,068 $ Amt:
24 | P a g e
School year busses PM route- 2 buses, 5:30-6:30 route to rural and city homes ($200/day) split 2/3 w other grant Summer Field Trips (1.5 buses x $200 trip x 4 trips) [locations include: Deception Pass State Park, Lake Padden, Padilla Bay Summer school busses AM and PM routes (1.5 buses x $100/run x 16 days x 2 runs/day) *Summer costs split with district ELL funds
N/A
Staff Development ($6941.90 staff time + $1041.29 benefits) Included in staffing costs above. In this time we will develop our Community of Practice as well as Circular Leadership model
$0
$ Amt: $500
YPQ Training workshops ($500)
$500
$ Amt: $3,680
[$1280] For YPQ In-house training/
evaluation/ observation/ meetings-- ($560) Two
teachers per diem rate of $35 x 8
hours; 2 Parents of $20 x 8 hours;
1 partner & students x 8 hrs each at $20 hr.
[$2400] Advisory Board time equals $300 per meeting
25 | P a g e
(8 meetings)
Evaluation N/A
$0
$ Amt: $9,879
For contracted services with Barbara Waxman, PhD. Costs to be split with Cohort 11 grant especially in terms of
travel as visitations can be grouped together. [$8881 EVALUATION
COSTS] --Onsite observations ($87.50/hr x
3hrs per month x 11 months)
Meetings with Director/ Coordinator ($87.50/hr x
2hrs per month x 11 months)
YQPA and YPQA-related activities (training,
meetings, certification, scoring) ($87.50/hr)
Development of instruments, analysis of
data for reports and meetings ($87.50/hr) Evaluation reports and
summaries ($87.50/hr x 5 hours x 2x year)
[$998 TRAVEL COSTS] Includes hotels, mileage,
per diem food
$9,879
$ Amt: $0
Travel costs can be shared with
Cohort 11 grant. Amount unknown.
26 | P a g e
Conferences N/A
$0
$ Amt: $2,100
Other conferences (300/ person) - Bridges, DO, XITO Institute, Latino
Center for Health (UW), Re-Imagining Race Based
Conversations (Global Peaceful Paths) etc.
Includes travel.
$2,100
$ Amt:
Facilities N/A
$0 $ Amt: $0
N/A
$0
$ Amt: $6,780
Facilties use including gym ($20/hr) and
school classrooms
YPQA Box Set of Materials Per Site (A minimum amount of $2200) N/A
The Office of Superintendent of Public Instruction (OSPI) will use this questionnaire to assess the subrecipient’s risk in consideration for issuance of a competitive subaward.
Subrecipient Name: Burlington-Edison School District
Date of Incorporation: (only non-profits/for-profits):
Preparer Name/Position: Joe Stewart
Date Prepared: 7/14/2017
Section A - Administrative
1 Is the subrecipient or any principals thereof suspended or debarred from receiving federal grants/contracts (www.sam.gov)? If yes, the subrecipient is not eligible to receive this subaward.
No
2 Does the subrecipient have experience administering federal awards within the past two years? If yes, please specify the program name, CFDA#, and amount of federal expenditures (or attach a Schedule of Expenditures of Federal Awards at bottom of page):
Select
28 | P a g e
3 Within the past year, has there been turnover in key position(s) who will be responsible for administering the award? If yes, please explain:
Select
4 Has the subrecipient ever had a government contract/project/agreement terminated? If yes, please explain:
No
5 Has the subrecipient had any known or suspected fraud or conflicts of interest potentially affecting federal awards? If yes, please explain:
No
Section B - Prior Audits and Monitoring
6 In the most recent financial statement audit, did the subrecipient:
• Receive an adverse opinion or a disclaimer of opinion? • Have any significant deficiencies or material weaknesses in internal control over
financial reporting?
If yes, please attach audit report at bottom of page.
No
7 In the most recent audit of federal programs, were there any findings? If yes, please attach audit report at bottom of page.
No
29 | P a g e
8 Has the subrecipient received monitoring by awarding agencies within the past two years? If there were any issues noted in the monitoring reviews, please attach the report(s) at bottom of page.
Yes
Section C - Financial
9 Has the subrecipient had any financial condition concerns within the past two years? If yes, please explain:
No
10 Does the subrecipient have any delinquent federal debt (www.sam.gov)? If yes, please explain:
No
11 Does the subrecipient have a federal negotiated indirect cost rate? If yes, please list the rate: 293 If no, please list the rate that will be applied to this subaward:
Yes
Section D - Internal Controls
12 Does the subrecipient’s financial management system:
• Identify all federal awards received and expended, including specific information pertaining to the award: federal program name; CFDA title and number;
Yes
30 | P a g e
identification number and year; and name of federal and any pass-through agency?
• Provide for accurate, current, and complete disclosure of the results of federal awards in accordance with reporting requirements?
• Include records and supporting documentation that identify the source and application of funds for federally funded activities, including authorizations, obligations, unobligated balances, expenditures, assets, income and interest?
• Enable the subrecipient to maintain effective internal controls to ensure accountability and proper safeguarding and use of all funds, property and other assets (for example, adequate segregation of duties)?
• Provide a comparison of expenditures with budget amounts for each federal award?
If no, please explain:
13 Does the subrecipient have a policy and procedures to ensure compliance with federal procurement requirements? If no, please explain:
Yes
14 Does the subrecipient have internal controls in place to ensure personnel expenses charged to a federal award are accurate, allowable, and properly allocated? If no, please explain:
Yes
Required Signatures:
31 | P a g e
21st CCLC Program Director: Bryan Jones
Finance Director for the District or Organization: Joe Stewart
Superintendent or CEO/ Designee of Organization: Laurel Browning
UPLOAD COMPLETED FILE(s) ON OR BEFORE DUE DATE
Uploaded Files Uploaded By Uploaded At
15.16 SEFA Final Modified for Clusters per SAO.xlsx Joe Stewart 7/14/2017
11:22 AM
Page 5
Attachments
Upload the following seven completed files on or before July 24, 2017, at 4:00 PM.
• Assurances for Eligible Entity Partnership and compliance with Program Regulations form; printed, signed and uploaded as an attachment (Pg. 1 of iGrants).
• Program Abstract (1 page)
32 | P a g e
• Program Narrative (25 pages maximum) (Amendment 28 pages maximum)
• Director, Site Coordinator, and Direct Services Staff Job Descriptions
• A 21st CCLC Program/Project Organizational Chart (1 page)
• Current Data Sharing Agreement signed by all parties that satisfies data use and sharing requirements outlined in assurances.
• Memorandum of Agreements (MOUs) between all major partners and fiscal agent signed by all authorized representatives
File names may not include symbols, including #.
Uploaded Files Uploaded By Uploaded At
LU- 21st CCLC Director.docx DAVID STRICH
7/21/2017 9:41 AM
LU- 21st CCLC Site Coordinator.docx
DAVID STRICH
7/21/2017 9:41 AM
LU- 21st CCLC Youth Enrich Teacher.docx
DAVID STRICH
7/21/2017 9:41 AM
33 | P a g e
LU- Assurances for Eligible Entity Partnership.pdf
DAVID STRICH
7/24/2017 12:10 PM
LU- Data Sharing Agreement - Burlington Public Library.pdf
DAVID STRICH
7/21/2017 3:45 PM
LU- Data Sharing Agreement - Community Action.pdf
DAVID STRICH
7/21/2017 3:45 PM
LU- Data Sharing Agreement - Western Washington University b.pdf
DAVID STRICH
7/24/2017 12:11 PM
LU- Data Sharing Agreement - Western Washington University.pdf
