APPLICATION PACKET



Application Cover Page

|District: | |Date: | |

|Project Manager: | |

|Position Title: | |

|Mailing Address: | |

|Project Manager’s Email | |

|Address: | |

|Tech Plan: |Check this page for your plan status: |

|LoTi Surveys: |Will be completed in your district by what date? | |

BE SURE TO READ ALL OF THE FOLLOWING

I hereby certify that:

1. To the best of my knowledge, the information contained in this application is correct, and the school board of the district named above has authorized me as its representative to submit this application.

2. The District has submitted to the New Hampshire Department of Education (NHDOE) a General Assurances signature page for the current year.

3. The District has consulted with the non-public schools and charter schools during the design and development of this Ed Tech project prior to all decisions that affect the opportunities of private school and charter school children to participate in the program.

4. All funding for this project will be obligated and reported no later than the quarterly report ending December 31, 2006 and expended and reported no later than quarterly report ending March 31, 2007.

5. The funds expended from this program will supplement, not supplant, funds from non-federal sources.

6. The District will keep records and provide information to the NHDOE as may be required for program evaluation, consistent with responsibilities under NCLB Title II-D, such as:

• Complete an annual NH School Technology Survey for each school building.

• Complete a Technology Progress Report for the 2nd round of funding (projects ending 6/30/05) describing impact of your Title II-D project and how you measured that impact.

• Ensure that 75% of staff complete the Level of Technology Implementation (LoTi) survey.

7. The schools to be funded by this program are CIPA compliant because the district employs a filtering mechanism for student access or because Ed Tech funds referenced in this application will NOT be used to purchase computers used to access the Internet or pay for direct costs associated with accessing the Internet.

Superintendent of Schools (blue ink preferred) Date

Submission deadline: Postmarked no later than December 31, 2005.

You can download the budget OBM Form 1 from oet/nclb.

Complete, sign, and mail application with budget OBM form 1 to:

Cathy Higgins, NH Department of Education, 101 Pleasant St, Concord NH 03301

Application Detail Page

|District: | |

| |

|Budget Description |

|The application guidance (pp 3-4) describes 11 allowable activities for these funds. Arrange your budget items within the five broad planning|

|categories of Access, Technology Literacy, Professional Development, Community Involvement, and Program Evaluation. You may add an optional |

|brief narrative at the bottom of this document if you feel your descriptions require further explanation. |

|Column 1: Provide a brief description to justify each item in your requested budget, such as: “the purchase of upgrades to existing computers|

|to increase the numbers of modern computers.” |

|Column 2: Indicate which schools will receive the services. |

|Column 3: Your activities must be aligned with goals and objectives in your district technology plan. Include an abbreviated version of the |

|corresponding goal statement from your district technology plan. |

|Column 4: Indicate which allowable activity aligns with each item requested. If you have more than one item and different activity types |

|within a category, use separate lines for each (add a row to the table). |

|Column 5: Provide the total for that category. Some categories may not be applicable. Professional development is always applicable for at |

|least 25% of your total allocation. |

|1 |2 |3 |4 |5 |

|Planning Category |School(s) to Receive |Addresses which District Tech|Aligns to activity #|Amount |

|And |Services |Plan Goal? |(choose one) | |

|Budget Item Description | | | | |

|Access to Tech Resources: | | |1, 2, or 3 | |

|Enter item description here | | | | |

|Technology Literacy: | | |4, 5, or 6 | |

|Enter item description here | | | | |

|Professional Development: | | |7 or 8 | |

|Enter item description here | | | | |

|Community Involvement: | | |9 | |

|Enter item description here | | | | |

|Program Evaluation: | | |10 or 11 | |

|Enter item description here | | | | |

|Indirect Cost: | | |

|TOTAL ALLOCATION: | | | | |

Submission deadline: Send this document as an email attachment

no later than December 31, 2005 to: chiggins@ed.state.nh.us

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