MICHIGAN DEPARTMENT OF EDUCATION



APPLICATION FORMS AND INSTRUCTIONSPublic Act 3 of 2021, Section 23e Before and After School/Summer Learning Community-Based Organization (CBO)MICHIGAN DEPARTMENT OF EDUCATION OFFICE OF GREAT STARTPRESCHOOL AND OUT-OF-SCHOOL TIME LEARNING INTRODUCTIONThe Michigan Department of Education (MDE) is pleased to announce the availability of funds for a grant to provide before and after school and/or summer learning in-person programming to serve children in kindergarten through grade 8. This grant opportunity will be awarded through a competitive application process from the federal fund money allocated under Michigan Public Act (P.A.) 3 of 2021, Section 23e sourced through the Governor’s Emergency Education Relief (GEER) fund under the Coronavirus Response and Relief Supplemental Appropriations Act, 2021, division M of Public Law 116-260 for 2020-rmation for this grant opportunity including the necessary forms and instructions for completing the application, are available on-line at . Applications must be received at the MDE by April 28, 2021 at 12:00 p.m. in PDF format with all pages attached in a single email to 21stcclc@ by no later than 12:00 p.m. on April 28th. Questions regarding this grant announcement may be directed via email to 21stcclc@.GRANT PURPOSE P.A. 3 of 2021, Section 23e provides $5,000,000 to be awarded through a competitive process to CBOs to provide before and after school and/or summer learning programming to children in kindergarten through eighth grade. CBOs must provide educational programming in core subject areas, including, but not limited to, mathematics, reading, and science. Programming must be provided in a manner in which the children are in-person at a building designated by the eligible entity. STATE BOARD OF EDUCATION GUIDING PRINCIPLES AND STRATEGIC GOALSThis grant supports the strategic goals of the State Board of Education (SBE) and the Michigan Department of Education (MDE), by aligning with Michigan’s Top 10 Strategic Education Plan, and the goals to improve the health, safety, and wellness of all learners and to improve early literacy achievement.GRANT RANGE AND FUNDING LIMITThe department shall distribute this funding to eligible entities through a competitive grant. Programs must start by no later than June 15, 2021. Applicants should base their budget on what is reasonable related to the number of children proposed to be served, number of weeks/hours/days and/or expansion of current services or programming.? MDE reserves the right, at its discretion, to determine grant award amount based on total applicants and availability of funds.TARGET POPULATION TO BE SERVEDThe target population is children in kindergarten or any or all of grades 1 to 8, or both.ELIGIBLE APPLICANTSAn eligible applicant must be a Community-Based Organization (CBO) that is exempt from federal income tax under section 501(c)(3) of the internal revenue code, 26 USC 501, and must provide all of the following, at a minimum:Before and after school and/or summer learning programming to children in kindergarten or any or all of grades 1 to 8, or both.Programming to children in a manner in which the children are in-person at a building designated by the eligible entity.Educational programming in core subject areas, including, but not limited to, mathematics, reading, and science.A consortium of CBOs may apply for multiple sites/centers where the applicant serves as the fiscal agent and is exempt from federal income tax under section 501(c)(3) of the internal revenue code, 26 USC 501, and must ensure provision of all of the above at each site/center.APPLICATION PRIORITYThe department shall prioritize, through awarding of additional priority points, distributing grant funding under this section to eligible entities that are:Located within districts or intermediate districts that currently do not provide before and after school and/or summer programming provided by the eligible entity. Meaning, there is not programming currently happening within the local district’s boundaries related to the purpose of this grant.Geographically distributed throughout the regions of the state. Licensed to operate school-age child care under the Michigan Licensing and Regulatory Affairs (LARA), Bureau of Community and Health Systems (BCHS), Child Care Licensing Division and meet the Guidelines for Safe Child Care Operations During COVID-19. Proposing to operate programming for five days a week for a minimum of 10 weeks for at least two hours a day during the school year and/or four hours a day in summer.APPLICATION SUBMISSION Complete the application in PDF format and attach all pages in a single email to 21stcclc@ by no later than 12:00 p.m. on April 28th.ACKNOWLEDGMENTAll publications including reports, films, brochures, and any project materials developed with funding from this program, must contain the following statement: “These materials were developed under a grant awarded by the Michigan Department of Education.”NONDISCRIMINATION AND OTHER COMPLIANCE WITH LAWApplications must include a statement of assurance of compliance with all federal and state laws and regulations prohibiting discrimination, with all requirements and regulations of MDE, and with appropriate state and local licensing laws and regulations governing childcare services for children of the appropriate age group served. AMERICANS WITH DISABILITIES ACTMDE is committed to providing equal access to all persons in admission to, or operation of its programs or services. Individuals with disabilities needing accommodations for effective participation in this program are invited to contact MDE for assistance.PAYMENT SCHEDULE All grantees are required to request funds, as needed, to reimburse for expenditures incurred by the program in accordance with the approved budget. Payment to the grantee is made through the MDE, Office of Financial Management. FINANCIAL REPORTINGAll invoices must be submitted to MDE within 60 days of the end date of this grant, September 30, 2021.PERFORMANCE REPORTING AND MONITORING RESPONSIBILITIESA grant recipient under this section shall administer before and after school/summer learning programming targeted at students in grades K-8 as described in P.A. 3 of 2021, Section 23e. Each entity receiving funds to implement the program shall report to the department on the number of children served, the types of services, and the outcome of those services.REVIEW PROCESSAward selections will be based on merit and quality, as determined by points awarded for the review criteria section and all relevant information (see Rejection of Proposals). The application rubrics will be used as a rating instrument in the review process. The application maximum score is 30 points with 20 additional priority points possible. The maximum score for the application is 50 points. Applicants with an application score below 28 will not be recommended for funding. All funding awards will be subject to approval by the State Superintendent. All applicants will be notified of the State Superintendent’s action. REJECTION OF PROPOSALSThe MDE reserves the right to reject any and all proposals received as a result of this announcement and will do so if the application does not adhere to eligibility in whole or in part or to negotiate separately with any sources whatsoever to serve the best interests of the State. Additionally, past performance on other grants, demonstrated knowledge of after-school programs or other relevant factors will be considered when recommendations for the grant award are made to the State Superintendent.APPEAL PROCESSThe MDE appeal process is available upon request to the MDE, Office of Great Start (OGS), Preschool and Out-of-School Time Learning (P&OSTL) by contacting 21stcclc@. ASSURANCES AND CERTIFICATIONSASSURANCE REGARDING SANCTIONS AGAINST IRAN LINKED BUSINESSESThe applicant assures that, for any request for proposals or contract renewal for work performed under this grant, it will collect a certification from each bidder that the bidder is not an Iran Linked Business. An Iran linked business is not eligible to submit a bid on a request for proposal with a public entity. Recipients must comply with all conditions under P.A. 517 of 2012, “Iran Economic Sanction Act,” April 1, 2013.ASSURANCE CONCERNING MATERIALS DEVELOPED WITH FUNDS AWARDED UNDER THIS GRANTThe grantee assures that the following statement will be included on any publication or project materials developed with funds awarded under this program, including reports, films, brochures, and flyers: “These materials were developed under a grant awarded by the Michigan Department of Education.”CERTIFICATION REGARDING NONDISCRIMINATION UNDER FEDERALLY AND STATE ASSISTED PROGRAMSThe grantee hereby agrees that it will comply with all federal and Michigan laws and regulations prohibiting discrimination and, in accordance therewith, no person, on the basis of race, color, religion, national origin or ancestry, age, sex, marital status or handicap, shall be discriminated against, excluded from participation in, denied the benefits of, or otherwise be subjected to discrimination in any program or activity for which it is responsible or for which it receives financial assistance from the U.S. Department of Education or the Michigan Department of Education.CERTIFICATION REGARDING TITLE II OF THE AMERICANS WITH DISABILITIES ACT (ADA), P.L. 101-336, STATE AND LOCAL GOVERNMENT SERVICESThe Americans with Disabilities Act (ADA) provides comprehensive civil rights protections for individuals with disabilities. Title II of the ADA covers programs, activities, and services of public entities. Title II requires that, “No qualified individual with a disability shall, by reason of such disability be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by such entity.” In accordance with Title II ADA provisions, the applicant has conducted a review of its employment and program/service delivery processes and has developed solutions to correcting barriers identified in the review.CERTIFICATION REGARDING TITLE III OF THE AMERICANS WITH DISABILITIES ACT (ADA), P.L. 101-336, PUBLIC ACCOMMODATIONS AND COMMERCIAL FACILITIESThe Americans with Disabilities Act (ADA) provides comprehensive civil rights protections for individuals with disabilities. Title III of the ADA covers public accommodations (private entities that affect commerce, such as museums, libraries, private schools and day care centers) and only addresses existing facilities and readily achievable barrier removal. In accordance with Title III provisions, the applicant has taken the necessary action to ensure that individuals with a disability are provided full and equal access to the goods, services, facilities, privileges, advantages, or accommodations offered by the applicant. In addition, a Title III entity, upon receiving a grant from the Michigan Department of Education, is required to meet the higher standards (i.e., program accessibility standards) as set forth in Title III of the ADA for the program or service for which they receive a grant. ASSURANCE REGARDING COMPLIANCE WITH GRANT PROGRAM REQUIREMENTSGrantee agrees to comply with all applicable requirements of all state statutes, federal laws, executive orders, regulations, policies, and award conditions governing this program. Grantee understands and agrees that if it materially fails to comply with the terms and conditions of the grant award, the Michigan Department of Education may withhold funds otherwise due to the grantee from this grant program, any other federal grant programs or the State School Aid Act of 1979 as amended, until the grantee comes into compliance or the matter has been adjudicated and the amount disallowed has been recaptured (forfeited). The Department may withhold up to 100 percent of any payment based on a monitoring finding, audit finding or pending final report. CERTIFICATION REGARDING NONDISCRIMINATION UNDER FEDERALLY AND STATE ASSISTED PROGRAMSThe applicant hereby agrees that it will comply with all federal and Michigan laws and regulations prohibiting discrimination and, in accordance therewith, no person, on the basis of race, color, religion, national origin or ancestry, age, sex, marital status or handicap, shall be discriminated against, excluded from participation in, denied the benefits of, or otherwise be subjected to discrimination in any program or activity for which it is responsible or for which it receives financial assistance from the U.S. Department of Education or the Michigan Department of Education.SUPPLEMENT/NON-SUPPLANTThis grant will not supplant nor duplicate an existing before and after school/summer learning program; including but not limited to the 21st Century Community Learning Centers Program (Title IV, Part B).SPECIFIC PROGRAM ASSURANCESShould the grant be awarded, the following provisions are understood by the grant recipients:The grant award is approved and is not assignable to a third party without specific approval.Funds shall be expended in conformity with the budget. Line-item changes and other deviations from the budget as attached to this grant agreement must have approval from the MDE, Office of Great Start, Preschool and Out-of-School Time Learning.MDE is not liable for any costs incurred by the grantee prior to the issuance of the grant award.Payments, records, and financial statements made to individual subrecipients under the provision of this grant will be made accessible and are subject to audit by the grantor.Each recipient shall comply with all reporting requirements and due dates.Each recipient acknowledges the program may be selected to participate in national, regional and/or state-wide out-of-school time data collection efforts.Acceptance of 23e funds requires that if the program is selected to be a part of an out-of-school time evaluation project that it will cooperate fully with the state, its designated evaluation contractor, and any of the state’s other research partners. That cooperation includes, but is not limited to:making classrooms available for observation;allowing administrators and staff to take time to complete surveys and questionnaires (by phone, online, on paper, or in-person as necessary);returning completed surveys and questionnaires promptly and regularly to the contractor or to any of the state’s other research partners; andproviding program information to the contractor or any of the state’s other research partners. This information may include but is not limited to; program type, session types, session hours, program calendar of school breaks, field trips, and staff development, site locations, number of youth served, and staffing assignments.SECTION II Selection Criteria and Application Forms begin on page 7.APPLICATION COVER PAGEOn the cover page, the organization submitting the application must be fully identified, as well as the contact person for this grant. All boxes must be appropriately completed, including signatures, addresses, telephone numbers, e-mail addresses, and the federal employer identification number (EIN) of the applicant organization. 02-65 Rev. 04/2021AUTHORITY: Public Act 3 OF 2021, Section 23eCOMPLETION: Voluntary, (consideration for funding will not be possible if form is not filed).Michigan Department of Education OFFICE OF GREAT STARTPreschool and Out-of-School Time Learning 608 W. Allegan StreetLansing, Michigan 48933Direct questions regarding these forms to (517) 275-1964.215265130810Public Act 3 OF 2021, Section 23e – Before and After School/Summer Learning – Community-Based Organization (CBO)00Public Act 3 OF 2021, Section 23e – Before and After School/Summer Learning – Community-Based Organization (CBO)APPLICANTORGANIZATIONLegal Name of ApplicantEnter NameEmployer ID NumberEINAddressAddressCity CityZip Code Zip CodePAGE ONE OF THE APPLICANT'S CURRENT IRS FORM 990 IS ATTACHED WITH THIS APPLCIATION. YES FORMCHECKBOX NO FORMCHECKBOX PRIMARY CONTACT PERSONName of Contact PersonName of ContactPrimary Phone(123) 456-7890Secondary Phone(123) 456-7890AddressAddressCityCityZip CodeZip CodeE-Mail AddressEmail AddressCountyCountySECONDARY CONTACT PERSONName of Contact PersonName of ContactPrimary Phone(123) 456-7890Secondary Phone(123) 456-7890AddressAddressCityCityZip CodeZip CodeE-Mail AddressEmail AddressCountyCounty22860017653000ASSURANCES AND CERTIFICATIONS: By signing this assurances and certifications statement, the applicant certifies that it will agree to perform all actions and support all intentions stated in the Assurances and Certifications on pages 4 through 7 and will comply with all state and federal regulations and requirements pertaining to this program. The applicant certifies further that the information submitted on this application is true and correct.SIGNATURE OF AUTHORIZED OFFICIAL Type to Sign28105101079500535559022542500151574522669500TYPED NAME/TITLE: Name/TitleDATE: MM/DD/YYAPPLICATION PRIORITY(20 Points Total)The department shall prioritize distributing grant funding under this section to eligible entities that are:Located within districts or intermediate districts that do not provide before and after school and/or summer programming provided by the eligible entity. Licensed to operate school-age child care under the Michigan Licensing and Regulatory Affairs (LARA), Bureau of Community and Health Systems (BCHS), Child Care Licensing Division and meet the Guidelines for Safe Child Care Operations During COVID-19. Proposing to operate programming for five days a week for a minimum of 10 weeks for at least two hours a day during the school year and/or four hours a day in summer. Geographically distributed throughout the regions of the state, as determined by the Michigan Department of Education based on distribution of current district funds used for before and after school/summer learning programs. Priority DescriptionDoes not meetMeetsLocated within districts or intermediate districts that do not provide before and after school and/or summer programming provided by the eligible entity. 0 points5 pointsLicensed to operate school-age child care under the Michigan Licensing and Regulatory Affairs (LARA), Bureau of Community and Health Systems (BCHS), Child Care Licensing Division and meet the Guidelines for Safe Child Care Operations During COVID-19. 0points10PointsProposing to operate programming for: PointsFive days a week for 10 weeks or more.5Four days a week for 10 weeks or more.4Five days a week for 8 weeks.3Four days a week for 8 weeks2Five days a week for six weeks.1Less than five days a week for six weeks.0Geographically distributed throughout the regions of the state, as determined by the Michigan Department of Education based on distribution of current district funds used for before and after school/summer learning programs. MDE will determine geographical distribution priority based on the regions represented amongst the high-quality applications. NARRATIVE PROPOSAL (15 POINTS TOTAL)Maximum four pages in length, that includes:a sample weekly schedule (not included in total pages);identified academic and enrichment opportunities in Mathematics; identified academic and enrichment opportunities in Reading; identified academic and enrichment opportunities in Science; and Social Emotional Learning (SEL) components. Not Recommended for Funding(0 points per box)Recommended for Funding with Revisions(1 point per box)Recommended for Funding(2 points per box)Highly Recommended for Funding(3 points per box)The application:The application:The application:The application:does not include a sample weekly schedule. includes a sample weekly schedule AND shows how mathematics OR reading OR science will be integrated.includes a sample weekly schedule AND shows how mathematics, reading, and science will be integrated.includes a sample weekly schedule AND shows how mathematics, reading, and science will be integrated AND identifies SEL components. does not include hands-on Mathematics activities and curriculum. includes hands-on Mathematics activities and curriculum.includes hands-on Mathematics activities and curriculum AND demonstrates embedded enrichment.includes hands-on Mathematics activities and curriculum AND demonstrates embedded enrichment AND indicates that activities and curriculum align with student school-day/schoolyear benchmarks. does not include hands-on Reading activities and curriculum. includes hands-on Reading activities and curriculum.includes hands-on Reading activities and curriculum AND demonstrates embedded enrichment.includes hands-on Reading activities and curriculum AND demonstrates embedded enrichment AND indicates that activities and curriculum align with student school-day/schoolyear benchmarks. does not include hands-on Science activities and curriculum. includes hands-on Science activities and curriculum.includes hands-on Science activities and curriculum AND demonstrates embedded enrichment.includes hands-on Science activities and curriculum AND demonstrates embedded enrichment AND indicates that activities and curriculum align with student school-day/schoolyear benchmarks. does not include includes SEL activities. includes SEL activities.includes SEL activities AND indicates how SEL activities support student to student relationships OR indicates how SEL activities support student to adult relationships. includes SEL activities AND indicates how SEL activities support student to student relationships AND indicates how SEL activities support student to adult relationships. Type Project Narrative Proposal Below (Maximum 4 Pages)Type Project Narrative HereQUALITY OF PERSONNEL (3 POINTS TOTAL)The applicant should identify individuals who will be associated with the project and its implementation. The applicant should address the qualities and qualifications of the individuals.Not Recommendedfor Funding(0 points)Recommended for Funding with Revisions(1 point)Recommendedfor Funding(2 points)Highly Recommendedfor Funding(3 points)The application:The application:The application:The application:does NOT designate responsibilities to specific personnel.designates responsibilities to specific personnel.designates responsibilities to specific personnel AND describes personnel qualified to develop, administer, and implement the project. designates responsibilities to specific personnel AND describes personnel qualified to develop, administer, and implement the project AND personnel have significant experience in the before/after school/summer learning field. Type Quality of Personnel Narrative Below (Maximum 2 Pages)Type Quality of Personnel Narrative HereCAPACITY (6 POINTS TOTAL)The applicant should describe current successful implementation of before/after school/summer learning and how the proposed project will increase capacity.Not Recommendedfor Funding(0 points)Recommended for Funding with Revisions(1 point)Recommendedfor Funding(2 points)Highly Recommendedfor Funding(3 points)The application:The application:The application:The application:does not provide evidence that the applicant has successfully implemented before/after school/summer learning programming. provides evidence that the applicant has successfully implemented before/after school/summer learning programming. provides evidence that the applicant has successfully implemented before/after school/summer learning programming AND proposes to serve additional students beyond current before/after school/summer learning programming offerings OR proposes to extend current programming by weeks/days/hours.provides evidence that the applicant has successfully implemented before/after school/summer learning programming AND proposes to serve additional students beyond current before/after school/summer learning programming offerings AND proposes to extend current programming by weeks/days/hours.does not provide evidence that either site capacity or license capacity is sufficient to serve number of youth in proposed project. N/AN/A provides evidence that the site capacity or license capacity is sufficient to serve number of youth in proposed project OR indicates site and/or license is able to be or will be modified to expand capacity to match proposed project. Type Capacity Narrative Below (Maximum 2 Pages)Type Capacity Narrative HereBUDGET(6 POINTS TOTAL)This section provides information to demonstrate that the project has an appropriate budget for the program and is cost-effective. The applicant must complete the enclosed budget summary and provide a budget detail identifying expenditures that are allowable under the budget guidelines.Not Recommended for Funding(0 points)Recommended for Funding with Revisions(1 point)Recommended for Funding(2 points)Highly Recommended for Funding(3 points)The application:The application:The application:The application:does NOT include a complete budget summary form OR a budget detail. includes a complete budget summary form but does NOT include a budget detail.includes a complete budget summary form AND a complete budget detail AND relates expenses to the planned program activities and staffing. includes expenditures that do NOT relate to the activities OR that are unallowable, unnecessary, or unreasonable. includes expenditures related directly to the activities proposed in the plan that are allowable, necessary, and reasonable. Use Budget Summary and Detail Forms (below) to Complete BUDGET - SUMMARYINSTRUCTIONS: The Budget Summary (1) and the Budget Detail (2) must be prepared by or with the cooperation of the Chief Financial Officer of the organization.BUDGET SUMMARYNUMBER: P.A. 3 of 2021 Section 23eLEGAL NAME OF APPLICANT Legal Name of ApplicantFY OF APPROVED ACTIVITYEMPLOYER ID NUMBER EINPROJECT TYPE: RegularENDING DATE: 09/30/212021FUNCTION TITLESALARIESBENEFITSPURCHASED SERVICESSUPPLIES & MATERIALSOTHER EXPENDITURESTOTALStaffingAmountAmountAmountAmountAmountAmountProfessional DevelopmentAmountAmountAmountAmountAmountAmountProgram Supplies and MaterialsAmountAmountAmountAmountAmountAmountProgram Services/VendorsAmountAmountAmountAmountAmountAmountGeneral AdministrationAmountAmountAmountAmountAmountAmountBusiness ServicesAmountAmountAmountAmountAmountAmountPupil Transportation ServicesAmountAmountAmountAmountAmountAmountFamily and Community ServicesAmountAmountAmountAmountAmountAmountTOTAL EXPENDITURESAmountMM/DD/YYName of CFOType to SignDATEORGANIZATION CHIEF FINANCIAL OFFICER (PRINT OR TYPE)SIGNATUREMM/DD/YYName of Main ContactType to SignDATEPROJECT MAIN CONTACT PERSON (PRINT OR TYPE)SIGNATUREMM/DD/YYLorraine ThoresonType to SignDATEMDE CONTACT PERSON (PRINT OR TYPE)SIGNATURE2. BUDGET – DETAILDirections:Complete all columns to describe the project expenditures. Enter each Type as many times as necessary to give a clear description of each expenditure type (click “choose one” to select type).Page Limit:Use Additional Budget Detail sheets, as needed. Additional Budget Detail sheets may be found at 21stcclc. TYPEDESCRIPTION OF EXPENDITURESAMOUNTChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountChoose OneEnter DescriptionAmountSITE: PROGRAM OPERATION TIMESComplete this form for each site that will provide before and after school and/or summer learning in-person programming to serve children in kindergarten through grade 8. Additional copies of this form may be found on the MDE website: 21stcclc. Proposing to operate programming for: PointsFive days a week for 10 weeks or more.5Four days a week for 10 weeks or more.4Five days a week for 8 weeks.3Four days a week for 8 weeks2Five days a week for six weeks.1Less than five days a week for six weeks.0SITE INFORMATIONSite number of total numberSITE/FACILITY NAMESite/Facility NameLICENSE NUMBERDC License NumberSITE/FACILITY ADDRESSSite/Facility AddressSCHOOL DISTRICT CODEDistrict CodeCITYCitySTATEStateZIP CODEZip CodeCOUNTYCountySITE/FACILITY CONTACT NAMESite/Facility Contact NameSITE/FACILITY PHONE(123) 456-7890SITE/FACILITY CONTACT EMAILSite/Facility Contact EmailPROGRAM INFORMATION DETAILSPROGRAM OPERATION DATESTOTAL NUMBER OF WEEKSWeeksSTART DATE StartEND DATE EndSUMMBER DAYS AND HOURS OF OPERATIONSCHOOL YEAR DAYS AND HOURS OF OPERATIONDAYSTART TIMEEND TIMEDAYSTART TIMEEND TIMEMONDAYStartEndMONDAYStartEndTUESDAYStartEndTUESDAYStartEndWEDNESDAYStartEndWEDNESDAYStartEndTHURSDAYStartEndTHURSDAYStartEndFRIDAYStartEndFRIDAYStartEndSATURDAYStartEndSATURDAYStartEndSUNDAYStartEndSUNDAYStartEndSTUDENT AND STAFFING INFORMATIONTOTAL PROPOSED NUMBER OF STUDENTS StudentsPROPOSED NUMBER OF SITE STAFF StaffGRADES TO BE SERVED (CHECK ALL THAT APPLY)K FORMCHECKBOX 1ST FORMCHECKBOX 2ND FORMCHECKBOX 3RD FORMCHECKBOX 4TH FORMCHECKBOX 5TH FORMCHECKBOX 6TH FORMCHECKBOX 7TH FORMCHECKBOX 8TH FORMCHECKBOX ................
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