WORKSHEET SAMPLE

This is a sample of a worksheet developed for last year’s New York State Learning Technology grant application. Upon request by authorized Level I and/or Level II users, One Stop Grants will create a similar worksheet to assist you in developing the proposal narrative for the specific grant your organization will be pursuing.

 

The University of the State of New York

STATE EDUCATION DEPARTMENT

Albany, New York 12234

 

 

2003-2004 Learning Technology Grants

Application Cover Page

 

Agency Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

School District or BOCES Name

Address

 

City                                                      County                                              Zip

 

Contact Person

 

Telephone (       )

 

E-mail Address

 

Fax (       )

 

 

Abstract

 

 

 

 

 

 

Statement of Assurances

Learning Technology Grant Program

 

 

            The Superintendent of Schools or the District Superintendent of the BOCES must sign and date this form and return it with the completed application.

 

1.       The application agency agrees to:

·        comply with statutory requirements for the use of funds as described under Section 550 of Chapter 170 of the Education Laws of 1994;

·        keep records, and provide information to the New York State Education Department that may be required for fiscal audits and program evaluation, consistent with the responsibilities of the New York State Education Department; and

·        assure that all activities are physically and programmatically accessible to students with disabilities and limited English proficiency.

 

2.       Materials and services provided through this partnership will be controlled by the applicant agency to be used only for activities outlined in the approved application.

 

3.       All programs, objectives, and expenditures proposed are directly related to, and for the purpose of, meeting the educational needs of public and nonpublic school students within the applicant region.

 

4.       Materials and services to nonpublic school students will be used only for secular, non-ideological, and neutral purposes.

 

The applicant agency hereby applies for participation to provide education activities and services as set forth in this application.

 

            I hereby certify that the information contained in this application is correct, and in total compliance with appropriate State laws and regulations.

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                                                                                                           

   Signature of District or BOCES Superintendent                                     Date

                                                                       

 

 

 

 

 

 

Required Commitments - Public School Buildings

Learning Technology Grant Program

(duplicate as needed)

 

 

Please complete this form for every public school building participating in the program.

 

Public School Principal

 

            I,                                                                                                           (name), as the educational leader of the                                                                                                                         school, will support the participation and collaborative work of teachers in my building in the proposed project, including the development of learning experiences appropriate for local, regional and Statewide Peer Review.

 

                                                                                    Signature of Principal

 

                       

                                                                                                                                                           

 

                                                                                    Date:                                                               

 

 

 

Head of the Teacher's Collective Bargaining Entity

 

            I,                                                                                                          (name), as the education leader of the                                                                                                    , will support the participation and collaborative work of teachers in the proposed project, including the development of learning experiences appropriate for local, regional and Statewide Peer Review.

 

                                                                                    Signature of Head of the Teacher's

                                                                                    Collective Bargaining Entity

 

 

                                                                                                                                                           

 

                                                                                    Date:                                                               

 

 

 

Required Commitments - Nonpublic Schools

Learning Technology Grant Program

(duplicate as needed)

 

 

            This form must be completed by each nonpublic school actually participating in this proposed project application.

 

            I,                                                                                                           (name), on behalf of my institution,                                                                                                                     am willing and able as documented herein, to support this proposal and am committed to its success. I will support my teachers in the development of learning experiences that are appropriate for local, regional and Statewide Peer Review.

 

                                                                                    Signature of Nonpublic School Principal

 

 

                                                                                                                                                           

                                                                                                           

 

Date:                                                               

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Participating School Data

 

 

A separate form must be completed for each school district and nonpublic school participating in the project.

               

Name of District/Non-Public                                                                                                                                                                       

 

Contact Person                                                            Telephone (        )                                                     

 

Address                                                                                                                                                         

 

Email Address                                                                                                                                                           

 

Participating Public/Non-Public Schools

·         School name

·         Contact person

·         Address

·         Email

·         Telephone number

Public (P) or Nonpublic (NP)

Technology Capacity

(student/

computer ratio)

Grade Levels Impacted

by

Project Activities

# Students Impacted

by

Project Activities

 

# Teachers

Participating in Project Activities

(by content area specialty)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROJECT NARRATIVE (Limit – 14 pages, double-spaced, 12 pt font)

 

1.  Description of the Applicant’s Need (10 points)

 

  1. Clear statement indicating the academic and technology needs to be addressed.

 

 

 

 

 

 

 

 

 

 

 

  1. Provide steps taken to assess the needs using relevant data (inc. NYS Report Cards) to substantiate these needs.

 

 

 

 

 

 

 

 

 

 

 

 

  1. Explain how grant integrates with overall technology plan of district.

 

 

 

 

 

 

 

 

 

 

  1. List schools benefiting from proposal, number of students, and teachers participating on School Data Form.

 

 

 

2.  Objectives (10 points)

 

List clear, realist measurable objectives that address the academic and technology needs listed above and link to NYS learning standards.

 

 

 

Objective

Need Address

Link to NYS Standards

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.  Project Activities, Outline and Timeline (25 points)

 

List activities, methods and strategies that will be conducted to achieve above state objectives.  Include timeline.  Activities must be based on research relevant to student attainment of NYS learning standards.

 

Activity, Method, Strategy inc.

Relevant Research

Objective Addressed

Timeline

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.  Collaborative Planning and Involvement of Nonpublic School (10 points)

 

a.       Describe process used to reach out to nonpublic schools of all denominations and nonsectarian private schools in the service area.  List all nonpublic schools contacted.

 

 

 

 

 

 

 

 

 

 

 

 

 

b.      Describe how nonpublic schools have participated in the planning of proposal.

 

 

 

 

 

 

 

 

 

 

 

 

c.      Describe how nonpublic schools will be full partners in the acquisition of equipment, software and the professional development of this project.  Include numbers to show equitable participation.

 

 

5.  Professional Development (20 points)

 

a.       Describe how professional development component is sustained over time and linked to needs, objectives and activities.

 

 

 

 

 

 

 

 

 

 

 

b.      Describe how classroom technology will be supported through technical assistance such as coaching, mentoring or peer demonstration.

 

 

 

 

 

 

 

 

 

 

 

 

 

c.      Describe how professional development will build the capacity of teachers to make use of web-based content, tools and resources such as the NYS Virtual Learning Space.

 

 

 

 

6. Project Evaluation (15 points)

 

a.       List clear, realistic and measurable objectives that will be made to determine impact of project on teachers’ capacity to integrate education technologies into classroom instruction.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b.     Describe how each activity is expected to contribute to increased student academic achievement of the NYS learning standards.