ࡱ>  LN?@ABCDEFGHIJK (bjbjUqUq 77~j lX X X X T%^@6 777?&*i|c TTTTTTT$5a UcU #U>l?##U7 X X 77]7 7 7 #*X *7 7T7 #T7 7 F : <17 Ét^ô)<1#]0%^vcl.c<17 X X X X MAINE DEPARTMENT OF EDUCATION  NO CHILD LEFT BEHIND (NCLB) ACT CONSOLIDATED APPLICATION FOR FUNDS FY 2005 (School Year 2004-2005) NAME OF UNIT  FORMTEXT       [City, Town, SAD or CSD] UNIT ADDRESS  FORMTEXT       TELEPHONE #  FORMTEXT       FAX #  FORMTEXT       E-MAIL  FORMTEXT       NCLB CONTACT PERSON  FORMTEXT       SCHOOL/DISTRICT OFFICE  FORMTEXT       ADDRESS  FORMTEXT       TELEPHONE #  FORMTEXT       FAX #  FORMTEXT       E-MAIL  FORMTEXT       I HEREBY CERTIFY that, to the best of my knowledge, the information contained in this application is correct; the school board of the unit named above has authorized me, as its representative, to submit this application. THE APPLICANT HEREBY ASSURES THE MAINE DEPARTMENT OF EDUCATION THAT THE SCHOOL UNIT WILL COMPLY WITH ALL ASSURANCES LISTED IN THIS APPLICATION. For Information Call: Title IA 624-6705 ______________________________ Title IC 624-6705 Signature, Superintendent of Schools Date:  FORMTEXT       Title IIA 624-6830 Title IID 624-6815  FORMTEXT       Title III 624-6788 Printed Name, Superintendent of Schools Title IVA 287-6475 Title V/REAP-Flex 624-6815 Technology Plans 1-800-322-8899 FAX #: 624-6706 Return Original and 3 CopiesTo:  Maine Department of Education NCLB Clearinghouse 23 State House Station  Augusta, ME 04333-0023 EF-U-430 Annual Due: August 1, 2004 3/02 wpdocs/reauthorization no child left behind/consolidated application/completed cons app. NCLB ASSURANCES Certification/Assurances Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the instructions for certification included in the regulations before completing this form. Signature of this form provides for compliance with certification requirements under 34 CFR Part 82, New Restrictions on Lobbying, and 34 CFR Part 85, Government-wide Debarment and Suspension (Nonprocurement) and Government-wide Require-ments for Drug-Free Workplace (Grants). The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of Education determines to award the covered transaction, grant, or cooperative agreement. 1. LOBBYING As required by Section 1352, Title 31 of the U.S. Code, and implemented at 34 CFR Part 82, for persons entering into a grant or cooperative agreement over $100,000, as defined at CFR 34 Part 82, Sections 82110, the applicant certifies that: (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making of any Federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement; (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, Disclosure Form to Report Lobbying, in accordance with its instructions; (c) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all subrecipients shall certify and disclose accordingly. 2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS As required by Executive Order 12549, Debarment and Suspension, and implemented at 34 CFR part 85, for prospective participants in primary covered transactions, as defined at 34 CFR Part 85, Sections 85.105 and 85.110- A. The applicant certifies that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification; and (d) Have not within a three-year period preceding this application had one or more public transactions (Federal, State, or local) terminated for cause or default; and B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application. 3. DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS) As required by the Drug-Free Workplace Act of 1988, and implemented at 34 CFR Part 85, Subpart F, for grantees, as defined at 34 CFR 85, Sections 85.605 and 85.610- A. The applicant certifies that it will or will continue to provide a drug-free workplace by; (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantees workplace and specifying the actions that will be taken against employees for violation of such prohibition; (b) Establishing an on-going drug-free awareness program to inform employees about- (1) The dangers of drug abuse in the workplace; (2) The grantees policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (c) Making it a requirement that each employee engaged in the performance of the grant be given a copy of statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph (a) that as a condition of employment under the grant, the employee will- (1) Abide by the terms of the statement; and (2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction; (e) Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (dX2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to: Director, Grants and Contracts Service, U.S. Department of Education, 400 Maryland Avenue, S.W. (Room 3124 GSA Regional Office Building No. 3), Washington, DC 20202-4571. Notice shall include the identification number(s) of each affected grant; (f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (dX2), with respect to any employee who is so convicted- (1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; (g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraph (a), (b), (c), (d), (e), and (f). B. The grantee may insert in the space provided below, the site(s) for the performance of work done in connection with the specific grant: Place of Performance (Street address, city, county, state, zip code)  FORMTEXT       Check [ FORMCHECKBOX  ] if there are workplaces on file that are not identified here. DRUG-FREE WORKPLACE (GRANTEES WHO ARE INDIVIDUALS) As required by the Drug-Free Workplace Act of 1988, and implemented at 34 CFR Part 85, Subpart F, for grantees, as defined at 34 CFR Part 85, Sections 85.605 and 85.610- A. As a condition of the grant, I certify that I will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant; and B. If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, I will report the conviction, in writing, within 10 calendar days of the conviction, to: Director, Grants and Contracts Service, U.S. Department of Education, 400 Maryland Avenue, S.W. (Room 3124, GSA ROB No.3), Washington, DC 20202-4571. Notice shall include the identification number(s) of each affected grant. Federal Gun Free Schools Act The federal Gun Free Schools Act, (No Child Left Behind Act of 2002, Public Law 107-110, Title IV, Part A, Section 4141), and Maine state law, (20-A MRSA, Section 1001, subpart-9A, Students Expelled or Suspended under the Requirements of the Federal Gun-Free Schools Act), requires that LEAs: Expel from school for at least one year a student who is determined to have brought a firearm to a school, or to have possessed a firearm at a school, (except that the federal and state laws shall allow the chief administering officer of such educational agency to modify such expulsion requirement for a student on a case-by-case basis), that they report the incident to the criminal justice or juvenile delinquency system, and that they provide the Maine Department of Education with annual documentation of the incidents. Nothing in this subpart shall be construed to prevent a State from allowing a local educational agency that has expelled a student from such a students regular school setting from providing educational services to such student in an alternative setting. The provisions of this section shall be construed in a manner consistent with the Individuals with Disabilities Education Act. Non-Construction Programs Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the applicant I certify that the applicant: 1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-Federal share of project costs) to ensure proper planning, management and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to prescribed standards for merit systems for programs funded under one of the nineteen statutes or regulations specified in Appendix A of OPMs Standards for a Merit System of Personnel Administration (5 CFR 900, subpart F). 6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-615), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to non-discrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s) which may apply to the application. 7. Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 8. Will comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. 9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. 276a to 276a-7), The Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327-333), regarding labor standards for federally assisted construction subagreements. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following; (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 1451 et seq.); (f) conformity of Federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205). 12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.) which prohibits the use of lead based paint in construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act of 1984. 18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this program. Sec. 9306 Other General Assurances a. Any applicant shall have on file with the SEA whether applying separately or pursuant to section 9305 a single set of assurances, applicable to each program for which a plan or application is submitted, that provides that-- (1) each such program will be administered in accordance with all applicable statutes, regulations, program plans, and applications (See MDOEs Annual Application Guidance for Title specific assurances); (2)(A) the control of funds provided under each such program and title to property acquired with program funds will be in a public agency or in a nonprofit private agency, institution, organization, or Indian tribe, if the law authorizing the program provides for assistance to such entities; and (2)(B) the public agency, nonprofit private agency institution, or organization, or Indian tribe will administer such funds and property to the extent required by the authorizing statutes; (3) the applicant will adopt and use proper methods of administering each such program, including-- (A) the enforcement of any obligations imposed by law on agencies, institutions, organizations, and other recipients responsible for carrying out each program; and (B) the correction of deficiencies in program operations that are identified through audits, monitoring, or evaluation; (4) the applicant will cooperate in carrying out any evaluation of each such program conducted by or for the SEA, the secretary, or other Federal officials; (5) the applicant will use such fiscal control and fund accounting procedures as will ensure proper disbursement of, and account for, Federal funds paid to such applicant under each such program; (6) the applicant will-- (A) make reports to the SEA and the Secretary as may be necessary to enable such agency and Secretary to perform their duties under each such program; and (B) maintain such records, provide such information, and afford access to the records as the SEA or the Secretary may find necessary to carry out the SEAs or the Secretarys duties; and (7) before the application was submitted, the applicant afforded a reasonable opportunity for public comment on the application and has considered such comment. b. GEPA Provision.--Section 442 of the General Education Provisions Act (GEPA) does not apply to programs under this Act. NCLB Title IA Planning Title IA Unit  FORMTEXT       Contact Person  FORMTEXT       Phone #  FORMTEXT       E-mail  FORMTEXT       DIRECTIONS: Federal law requires each local educational agency (LEA) to have a plan to address specific components of its educational program that is approved by the state educational agency (SEA). The required components are to be addressed on a separate sheet of paper and included in this application packet. The process for having the documentation available during an on-site NCLB monitoring visit last year did not prove effective; it created citations that we want to avoid in the future. Title IA, Sec. 1112 requires each LEA plan to be coordinated with other NCLB programs, the Individuals with Disabilities Education Act, the Carl D. Perkins Vocational and Technical Education Act of 1998, the McKinney-Vento Homeless Assistance Act and other acts as appropriate. The plan must address the following provisions: ( HYPERLINK "http://www.state.me.us/education/nclb/tia" http://www.state.me.us/education/nclb/tia) Described how the LEA will coordinate and integrate Title I services with other education services at the LEA or school level, specifically coordination between Title I and Even Start, Head Start, Reading First Early Reading First and other preschools programs.  FORMTEXT       Describe how the LEA plans to coordinate services for children with limited English proficiency, children with disabilities, migratory children, neglected or delinquent youth, homeless children, and immigrant children to increase program effectiveness, eliminate duplication, and reduce fragmentation of the instructional program.  FORMTEXT       C. Describe how the LEA uses additional high-quality student academic assessments in its Title IA program other than the state educational agency (SEA) mandated Maine Educational Assessment (MEA) and comprehensive local assessments.  FORMTEXT       D. Describe how the LEA ensures that teachers, in consultation with parents, administrators, and pupil services personnel, will identify the eligible children most in need of services under Title IA and how Migrant students will be selected on the same basis as other children.  FORMTEXT       E. Described the strategy the LEA will use to coordinate programs under this part with programs under Title II, Part A to provide professional development for teachers, paraprofessionals, and principals, and if appropriate, other staff to meet the requirements of Sec. 1119 Teacher Quality.  FORMTEXT       F. Described the strategy the LEA will use to implement effective parent involvement under Section 1118 including how it will communicate with parents and include Title IA parents in the development and evaluation of the Title IA program.  FORMTEXT       G. Described the actions the LEA will take to assist its low-achieving schools identified for improvement, as well as any arrangements it will make for public school choice and supplemental services. (Detailed information regarding school improvement will be available in the Maine School Improvement Handbook which will be posted to the NCLB web site by July 1, 2004.  FORMTEXT       H. The LEA will meet the general assurances contained in Section 1112(c) A-O. (See assurances in the Guidance for the Consolidated Application 2003-2004 or at  HYPERLINK "http://www.state.me.us.education/nclb/tia" http://www.state.me.us.education/nclb/tia)  FORMCHECKBOX YES  FORMCHECKBOX NO (If no, the district can not apply for money under Title IA). I. The LEA agrees to transfer funds to another district for equitable services for private school students residing in the district and attending private school in another district as reported on the districts final Title IA allocation documents.  FORMCHECKBOX YES  FORMCHECKBOX Not Applicable  FORMCHECKBOX NO (If no, the district will have to provide Title 1A services to the child(ren) at the private school(s). NCLB Needs Assessment and Planning Title IIA Unit  FORMTEXT       Contact Person  FORMTEXT       Phone #  FORMTEXT       E-mail  FORMTEXT       The ESEA s requirements for Title II, Part A planning are intended to have each school district  think outside the box. In carrying out the planning process, school administrators, teachers, other school staff and parents should work together to examine comprehensively all approaches and strategies that can help the LEA ensure that all of its teachers current and those newly hired are highly qualified, and also that teachers are able to help all students succeed academically to the fullest extent. This process will help ensure that all students are able to achieve challenging content and student academic achievement standards. While information supporting these requirements does not need to be submitted with this application, documentation must be available for review upon request and should be kept in the NCLB section of the CEP. (Section 2122) (Refer to Systemic Professional Training and Development: A How To for No Child Left Behind at  HYPERLINK "http://www.state.me.us/education/nclb/tiia" www.state.me.us/education/nclb/tiia.) A. A local professional development needs assessment has been conducted to determine the needs of the LEAs educators to provide all students the opportunity to achieve Maines Learning Results. The results of the needs assessment are available for review.  FORMCHECKBOX YES  FORMCHECKBOX NO (If  no , describe how this will be accomplished and the date for completion.)  FORMTEXT       B. The activities that the LEA will carry out with Title II, Part A funds align with Maines Learning Results, the Maine Education Assessment, and curricula and programs tied to these standards.  FORMCHECKBOX YES  FORMCHECKBOX NO (If no, describe how this will be accomplished and the date for completion.)  FORMTEXT       C. The proposed activities are based on the needs identified through the local professional development needs assessment and a review of scientifically based research. It is anticipated that the activities will have a substantial, measurable, and positive impact on student academic achievement.  FORMCHECKBOX YES  FORMCHECKBOX NO (If  no , describe how this will be accomplished and the date for completion.)  FORMTEXT       D. The LEA has coordinated the professional development activities authorized under Title II, Part A with professional development activities provided through other Federal (including Title I and Title II, Part D), State (including PPPD), and local programs.  FORMCHECKBOX YES  FORMCHECKBOX NO (If no, describe how this will be accomplished and the date for completion.)  FORMTEXT       E. The LEA s teachers, paraprofessionals, principals, other relevant school personnel and parents have collaborated in the planning process and will collaborate in the activities to be undertaken.  FORMCHECKBOX YES  FORMCHECKBOX NO (If  no , describe how this will be accomplished and the date for completion.)  FORMTEXT       F. The LEA provides training to enable teachers to (1) teach to the needs of students with different learning styles  particularly students with disabilities, students with special learning needs (including those who are gifted and talented), and those with limited English proficiency; (2) improve student behavior in the classroom; (3) involve parents in their childs education; and (4) understand and use data and assessments to improve classroom practice and student learning.  FORMCHECKBOX YES  FORMCHECKBOX NO (If no, describe how this will be accomplished and the date for completion.)  FORMTEXT       G. The LEA has established annual measurable objectives to increase the percentage of  highly qualified teachers in the LEA and in each school. (ESEA Title I, section 1119) (See Highly Qualified Teachers at  HYPERLINK "http://www.state.me.us/education/nclb/tiia" www.state.me.us/education/nclb/tiia.)  FORMCHECKBOX YES  FORMCHECKBOX NO (If  no , describe how this will be accomplished and the date for completion.)  FORMTEXT       H. The LEA has set goals to achieve an annual increase in the percentage of teachers who receive high-quality professional development. (Section 2122) (See High Quality Professional Development at  HYPERLINK "http://www.state.me.us/education/nclb/tiia" www.state.me.us/education/nclb/tiia.)  FORMCHECKBOX YES  FORMCHECKBOX NO (If no, describe how this will be accomplished and the date for completion.)  FORMTEXT       I. The LEA has targeted funds to schools that have the lowest proportion of  highly qualified teachers, have the largest average class size, and /or are identified for school improvement under Title I, section 1116(b). (Section 2122)  FORMCHECKBOX YES  FORMCHECKBOX NO (If  no , describe how this will be accomplished and the date for completion.)  FORMTEXT       Wpdocs/Jackie/Title IA LEA Plan NO CHILD LEFT BEHIND (NCLB) ACT CONSOLIDATED NON-PUBLIC SCHOOL PARTICIPATION SCHOOL YEAR 2004-2005  FORMTEXT        FORMTEXT       NON-PUBLIC SCHOOL NAME AND TITLE OF PERSON COMPLETING FORM  FORMTEXT        FORMTEXT       ADDRESS PHONE NO.  FORMTEXT       CITY, STATE, ZIP COMPLETE ONE OF THE FOLLOWING BOXES and return to the local school district whether or not you plan to participate. Our school DOES wish to participate in one or more of the NCLB programs and assures that: This school has been consulted IN A TIMELY AND MEANINGFUL MANNER in the planning of the consolidated NCLB application and is satisfied with the educational services to be offered. The services, materials and/or equipment provided through any of the NCLB programs will be used to provide only secular, neutral and nonideological educational services to student and school personnel. Non-public schools which are controlled by a religious organization and who receive services under the NCLB grant programs are in compliance with Title IV of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973. Non-public schools which are not controlled by a religious organization and who receive services under the NCLB grant programs are in compliance with Title IV of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990. Any printed (or other media) description or discussion of NCLB programs will state the total amount being spent on the project or activity and will indicate the percentage of funds from the NCLB programs which are involved (Stevens Amendment). PLEASE ( THE PROGRAMS IN WHICH YOU WISH TO PARTICIPATE: (DESIRED PROGRAMS MUST BE CHECKED BEFORE APPROVAL OF APPLICATION)  FORMCHECKBOX Title IA Education for the Disadvantaged (Available to approved private schools that complied with reporting, low income students)  FORMCHECKBOX  Title IC Migrant Education Program  FORMCHECKBOX  Title IIA Improving Teacher Quality  FORMCHECKBOX  Title IID Ed Tech (Technology Grant)  FORMCHECKBOX  Title IVA Safe & Drug Free Schools & Communities Act  FORMCHECKBOX  Title V Innovative Education  ________________________________________________ _____ Signature & Title of Authorized Non-Public School Representative Date  Our school DOES NOT wish to participate in any NCLB Programs.  _______________________________________________ Signature & Title of Authorized Non-Public School Representative _____ DateFor Information Call: ( Return Original and 1 Copy Before July 1, 2004, To: ( The Local Public School Superintendent The Local Public School Superintendent or NCLB Clearinghouse 624-6705 DUPLICATE FORM AS NECESSARY CERTIFICATION FOR PARTICIPATION IN NCLB COOPERATIVE PROJECT Each of the undersigned certifies that, to the best of his/her knowledge, the information contained in this Application is correct and complete; that the local or State agency which he/she represents has authorized him/her to file this Application, and that such authorization is recorded in the minutes of the agency(s) meeting held on the date shown below. The participating or intermediate educational agency named below in Part A has been designated as the administrative and fiscal agent for this project and is authorized to receive and expend for the conduct of this project NCLB funds in the amounts not to exceed entitlements under this Certification. All participating agencies have entered into an agreement concerning the final disposition of equipment, facilities, and material purchased for this project from NCLB funds. A. CERTIFICATION OF AGENCY DESIGNATED ADMINISTRA- TIVE AND FISCAL AGENT FOR THIS PROJECT DATE LEA MEETING WAS HELD  FORMTEXT      LEGAL NAME OF AGENCY  FORMTEXT      NAME & TITLE OF AUTHORIZED REPRESENTATIVE  FORMTEXT      MAILING ADDRESS OF AGENCY (Street, City, Town, Zip Code)  FORMTEXT      SIGNATURE DATE OF SIGNATURE  FORMTEXT       COUNTY STATE  FORMTEXT      TELEPHONE # OF AUTHORIZED REP  FORMTEXT       TELEPHONE # OF CONTACT PERSON  FORMTEXT      NAME AND TITLE OF CONTACT PERSON  FORMTEXT      MAILING ADDRESS OF CONTACT PERSON  FORMTEXT      B. CERTIFICATION OF PARTICIPATING AGENCYDATE LEA MEETING WAS HELD  FORMTEXT       LEGAL NAME OF AGENCY  FORMTEXT      NAME & TITLE OF AUTHORIZED REPRESENTATIVE  FORMTEXT      MAILING ADDRESS (Street, City, Town, Zip Code)  FORMTEXT      SIGNATURE DATE OF SIGNATURE  FORMTEXT       COUNTY STATE  FORMTEXT      TELEPHONE # OF AUTHORIZED REP  FORMTEXT       TELEPHONE # OF CONTACT PERSON  FORMTEXT      NAME AND TITLE OF CONTACT PERSON  FORMTEXT      MAILING ADDRESS OF CONTACT PERSON  FORMTEXT      C. CERTIFICATION OF PARTICIPATING AGENCYDATE LEA MEETING WAS HELD  FORMTEXT       LEGAL NAME OF AGENCY  FORMTEXT      NAME & TITLE OF AUTHORIZED REPRESENTATIVE  FORMTEXT      MAILING ADDRESS (Street, City, Town, Zip Code)  FORMTEXT       SIGNATURE DATE OF SIGNATURE  FORMTEXT       COUNTY STATE  FORMTEXT      TELEPHONE # OF AUTHORIZED REP  FORMTEXT       TELEPHONE # OF CONTACT PERSON  FORMTEXT      NAME AND TITLE OF CONTACT PERSON  FORMTEXT      MAILING ADDRESS OF CONTACT PERSON  FORMTEXT      D. CERTIFICATION OF PARTICIPATING AGENCYDATE LEA MEETING WAS HELD  FORMTEXT       LEGAL NAME OF AGENCY  FORMTEXT      NAME & TITLE OF AUTHORIZED REPRESENTATIVE  FORMTEXT      MAILING ADDRESS (Street, City, Town, Zip Code)  FORMTEXT      SIGNATURE DATE OF SIGNATURE  FORMTEXT       COUNTY STATE  FORMTEXT      TELEPHONE # OF AUTHORIZED REP  FORMTEXT       TELEPHONE # OF CONTACT PERSON  FORMTEXT      NAME AND TITLE OF CONTACT PERSON  FORMTEXT      MAILING ADDRESS OF CONTACT PERSON  FORMTEXT       CONSOLIDATED REQUEST FOR DISBURSEMENT OF NCLB FEDERAL FUNDS UNIT  FORMTEXT       CONTACT PERSON  FORMTEXT       PHONE  FORMTEXT       BUSINESS MANAGER SIGNATURE RECOMMENDED __________________ PHONE  FORMTEXT       Instructions: Complete the table for each of the programs in which your school participates. Use whole dollars only (no cents) and include non-public school amounts. The total for each program should equal the school year 2004-2005 allocation amount prior to any transfer of funds. Do not include carryover amounts from the previous year. Please schedule Title IVA payment(s) for the month(s) of October, January, and/or April. NCLB Program ( Title I A Education for the Disadvantaged (3702)Title I C Migrant Ed Program (3703)Title IIA Improving Teacher Quality Program (2001)Title IID Ed Tech Program (Technology) (1901)Title IVA Safe and Drug Free Schools (Office of Substance Abuse)Title V Innovative Education Program (3802) --State Use Only-- FY05 Funds FY05 Fiscal Year Town Code_________FY 05 Allocation ( Month FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      September FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      October FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      November FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      December FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      January FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      February FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      ` FORMTEXT      March FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      April FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      May FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      --State Use Only-- GAS [ ] Initials:____________ Date:______________ Batch Rev__________ June FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      July FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      August FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       Total FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       NCLB APPLICATION DEVELOPMENT TEAM UNIT  FORMTEXT       School Year  FORMTEXT       PLEASE TYPE IN THE NAMES OF THE MEMBERS OF YOUR TEAM IN THE APPROPRIATE AREAS ADMINISTRATOR(S)  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT         FORMTEXT       Title IA  FORMTEXT       Title IC  FORMTEXT       Title I IA  FORMTEXT       Title I ID  FORMTEXT       Title IVA  FORMTEXT       Title V  FORMTEXT       IDEA Rep.  FORMTEXT       Learning Results TEACHERS  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       PARENT(S)  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       STUDENT(S)  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       COMMUNITY MEMBERS  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       NCLB Individual Program Contact Sheet (If different from NCLB Contact) Please ensure accurate e-mail addresses as the use of electronic distribution of information increases. Title IA Education for the Disadvantaged Contact Person  FORMTEXT       Phone #  FORMTEXT       Contact s Work Address  FORMTEXT       FAX #  FORMTEXT       E-mail  FORMTEXT       Title IC Migrant Education Program Contact Person  FORMTEXT       Phone #  FORMTEXT       Contact s Work Address  FORMTEXT       FAX #  FORMTEXT       E-mail  FORMTEXT       Title IIA Teacher Quality Contact Person  FORMTEXT       Phone #  FORMTEXT       Contact s Work Address  FORMTEXT       FAX #  FORMTEXT       E-mail  FORMTEXT       Title IID Ed Tech Program (Technology) Contact Person  FORMTEXT       Phone #  FORMTEXT       Contact s Work Address  FORMTEXT       FAX #  FORMTEXT       E-mail  FORMTEXT       Title IVA Safe & Drug-Free Schools & Communities Program Contact Person  FORMTEXT       Phone #  FORMTEXT       Contact s Work Address  FORMTEXT       FAX #  FORMTEXT       E-mail  FORMTEXT       Title V Innovative Education Program Contact Person  FORMTEXT       Phone #  FORMTEXT       Contact s Work Address  FORMTEXT       FAX #  FORMTEXT       E-mail  FORMTEXT       NCLB Financial Transfer Worksheet: This form is completed only by districts using the transferability options of NCLB; all others go to next page. This page is NOT TO BE USED FOR REAP-FLEX. Unit  FORMTEXT       Contact  FORMTEXT       Phone #  FORMTEXT       E-mail  FORMTEXT       Use whole dollars (no cents). TitleIAIIAIIDIVAVTotals(a) Allocations  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT      ((b) Transfers To: Up to 50% to Titles listed from amount in Row (a) FORMTEXT      IA  FORMTEXT      IID I FORMTEXT      VA  FORMTEXT      V  FORMTEXT      IA  FORMTEXT      IIA  FORMTEXT      IVA  FORMTEXT      V  FORMTEXT      IA  FORMTEXT      IIA  FORMTEXT      II D  FORMTEXT      V  FORMTEXT      IA  FORMTEXT      IIA  FORMTEXT      II D  FORMTEXT      IVA (c) Total To Be Transferred OUT: From Row (b)   FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT      ((d) Total To Be Transferred IN. From Titles listed in Row (b)   FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT      ((e) Adjusted Title Totals (a)-(c)+(d) Funds available for projects   FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT      (Copy amounts to Row (a) on Pg. E-10  IA Education for the Disadvantaged IID--Ed Tech (Technology) IIATeacher Quality VInnovative Education Row (e) total must = Row (a) total ( IVA--Safe & Drug Free Schools & Communities Act Row (c) total must = Row (d) total ( NCLB Summary of Project Totals By Title Unit  FORMTEXT       Contact  FORMTEXT       Phone #  FORMTEXT       E-mail  FORMTEXT       Use whole dollars (no cents). An  R in Row (b) after an amount indicates the funds are used under the REAP-Flex option. TitleIAICIIAIIDIVAVTotals((a) Allocation --- Or --- Adjusted Totals from Row (e) of the NBLC Financial Transfer Worksheet (E-9) FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      ((b) Project Totals Enter the project total from each individual project sheet.  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT      ((c) Column Totals Sum of Project Totals listed in Row (b) (b) must = (a) FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      ( Row Totals for (a), (b) and (c) must be the same ( IA-- Education for the Disadvantaged IC--Migrant Education Program IIA-- Teacher Quality IID--Ed Tech (Technology) IVA--Safe & Drug Free Schools and Communities Act V-- Innovative Education REAP-Flex Project Sheet This form is used to calculate the funding source and amount of a REAP-Flex-Flex (Rural Education Achievement Program) project. This form combined with the proper NCLB Project Sheet (description of the activity) are required to participate in REAP-Flex. Please use one form E-11 and one proper NCLB Project Sheet for each comprehensive REAP-Flex project. Duplicate as needed. Unit:  FORMTEXT       Contact:  FORMTEXT       Phone #:  FORMTEXT       Email:  FORMTEXT       Project Title:  FORMTEXT       Description (one sentence short version):  FORMTEXT       (Note: The full project description and outcomes are submitted on the proper NCLB Project Sheet). Projects under Title III or Title IVB will use forms obtained from their State Program Directors. PART I: Check only one box below indicating the NCLB Title under which this REAP-Flex project will be conducted. Attach a corresponding Project Sheet from the checked Title.  FORMCHECKBOX Title I A (Education for the Disadvantaged)  FORMCHECKBOX Title IIA (Teacher Quality)  FORMCHECKBOX Title IID (Ed Technology)  FORMCHECKBOX Title III (Language Instruction for Limited English Proficient Students)  FORMCHECKBOX Title IVA (Safe and Drug-Free Schools & Communities Act)  FORMCHECKBOX Title IVB (21st Century Grants)  FORMCHECKBOX Title V (Innovative Education) PART II: In the table below indicate the amount(s) and sources of funding for this REAP-Flex project. This total will be used for the budget on the Project Sheet in PART I above. On Page E-10, the funds should be listed in Row (b) under the original NCLB Title(s) with an R (for REAP-Flex) after the amount. NCLB TitleFunds to be used for this REAP-Flex project These amounts in the second column should be listed on page E-10, Row (b) under their original title with an R after the amount. Title IIA Teacher Quality $ FORMTEXT      RTitle IID Ed Tech (Technology) $ FORMTEXT      RTitle IVA  Safe & Drug-Free Schools & Communities Act $ FORMTEXT      RTitle V  Innovative Education $ FORMTEXT      RTotal - Transfer this amount to a proper NCLB Project Sheet budget. ( $ FORMTEXT       NCLB Project Sheet TITLE IA Please use a separate sheet for each of your Title IA-funded projects. Duplicate project sheet as needed. Unit  FORMTEXT       Project Title  FORMTEXT       If non-public school project, provide non-public School Name  FORMTEXT       1. Purpose: Provide supplemental programs for helping educationally disadvantaged children to achieve the Maine Learning Results. 2. Project Description: Describe your program. Identify who will implement it, who will be served, and what subject/area the project will cover.  FORMTEXT       3. Outcomes/Performance Indicators: (A well written outcome is realistic, clear, specific and measurable) How will you know your project was successful? Identify the assessment you will use to measure progress and identify the progress you expect based on this assessment.  FORMTEXT       4. Project Budget: Use whole dollars only (no cents) Salaries & Benefits (100, 200)Contracts (300-500)Travel (500)Supp/ Books (600)Equipment (700)Capital Equipment (780)Other (890)Project Total ( [Copy to Pg. E-10 Row (b)] FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       ( If this is a REAP-Flex project, see REAP-Flex Project Sheet (E-11). Do not copy this amount to Pg. E-10. Ranking Of Schools & Distribution of FY05 Funds (Do not include carryover funds) TITLE IA  Unit  FORMTEXT       Low Income Measure Used  FORMTEXT       This block must be completed by LEA s with 1000+ students Allocation $ FORMTEXT       + Transfer $ FORMTEXT       = $ FORMTEXT       New Alloc serving any school(s) with a poverty percentage less than 35%. Other: Specify:  FORMTEXT       $ FORMTEXT        Other: Specify:  FORMTEXT       $ FORMTEXT       Other: Specify:  FORMTEXT       $ FORMTEXT       Other: Specify:  FORMTEXT       $ FORMTEXT        FORMTEXT       (  FORMTEXT       *  FORMTEXT       (  FORMTEXT       Other: Specify:  FORMTEXT       $ FORMTEXT       Other: Specify:  FORMTEXT       $ FORMTEXT       Amount Dedicated to Schools: $ FORMTEXT       ALL LEAs MUST COMPLETE THE TABLE BELOW: LIST ALL DISTRICT SCHOOLS IN RANK ORDER: -- BY PERCENT OF LOW INCOME STUDENTS IN ATTENDANCE OR -- BY GRADE SPAN (1)GRADE SPAN (2)ENROLLMENT (3)# OF LOW INCOME (4)PERCENT LOW INCOME (5)ELIGIBLE( (Yes or No) (6)PER PUPIL EXPENDITURE BY SCHOOL (7)TOTAL FUNDING FOR EACH SCHOOL ** (8)TOTAL STAFF FUNDING FOR EACH SCHOOL( (9) FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       TOTALS FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      ! See Test Case #3 in the Test Case guidance. ( Sec. 1113(b)(C) A school that is not eligible may be served for one additional fiscal year if it was eligible and served in the preceding fiscal year. ** If the district has an AYP Continuous Improvement Priority School (CIPS), 10% of the School Funding (column 8) must be used for staff development that addresses the academic achievement problem that caused the school to be identified for school improvement, and a Project Sheet must be developed. ( Column 9 should align with staff information provided on page E-14. Staff Information Title IA UNIT  FORMTEXT       TITLE IA STAFF INFORMATION: Local and federal carryover funds must not be included on this page. PLACE ( IF NEW HIRENAME OF EMPLOYEEPOSITION* SCHOOL If position is split among schools, list the % of time spent at each school.TITLE I HOURS PER WEEKNUMBER OF WEEKSTOTAL TITLE I SALARY INCLUDING BENEFITSALARY DIFFEREN-TIAL AMOUNTTITLE I SALARY FOR SCHOOL LEVEL FUNDING  FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      TOTAL must equal the total salary and benefits column for all Title IA Projects TOTAL Title IA Salaries  FORMTEXT       SAL DIF SETASIDE for DISTRICT  FORMTEXT      AMOUT FOR STAFF FUNDING FOR SCHOOLS COL (9)  FORMTEXT        * Please list paraprofessionals as Ed. Tech. I, II, III. * List all persons receiving a salary or stipend from Title IA funds i.e. If the NCLB or the Title IA Coordinator is paid with Title IA funds, list on this form. List the persons name twice if already listed in another position. Summer school staff should be listed as a block employee. F\wpdocs\lois\NCLBform\con00-2 COMPARABILITY Title IA Sec. 1120A(c): An LEA may receive Part A funds only if it uses State and local funds to provide services in Part A schools that are at least comparable to the services provided in schools that are not receiving Part A funds. An LEA that services all of its schools must ensure comparable services using State and local funds at each school. An LEA may determine comparability on a districtwide basis or on a grade-span basis. The comparability requirement does not apply to an LEA that has only one building at each grade level. An LEA may also exclude schools with 100 or fewer students from its comparability determinations. Section I. The LEA has only one building at each grade level. ____Yes [Comparability does not apply. Go to next page]. ____No [Go to Section II.]  Section II. IN PROCESS OF BEING DEVELOPED. NCLB Project Sheet Migrant Education-Title IC Unit  FORMTEXT       Project Title Program Services and Evaluation 1. Purpose: The purpose of the Migrant Program is to provide services to eligible migrant students so they can achieve the Maine s Learning Results at the same rate as non-migrant students. 2. Project Description:  FORMTEXT       3. Outcome/Performance Indicators: The percentage of grade 4 migrant students who meet or exceed reading/language arts standards on MEA will be the same as grade 4 non-migrant students. The percentage of grade 4 migrant students who meet or exceed writing standards on MEA will be the same as grade 4 non-migrant students. The percentage of grade 4 migrant students who meet or exceed mathematics standards on MEA will be the same as grade 4 non-migrant students. The percentage of grade 8 migrant students who meet or exceed reading/language arts standards on MEA will be the same as grade 8 non-migrant students. The percentage of grade 8 migrant students who meet or exceed writing standards on MEA will be the same as grade 8 non-migrant students. The percentage of grade 8 migrant students who meet or exceed mathematics standards on MEA will be the same as grade 8 non-migrant students. The percentage of grade 11 migrant students who meet or exceed reading/language arts standards on MEA will be the same as grade 11 non-migrant students. The percentage of grade 11 migrant students who meet or exceed writing standards on MEA will be the same as grade 11 non-migrant students. The percentage of grade 11 migrant students who meet or exceed mathematics standards on MEA will be the same as grade 11 non-migrant students. Migrant students in grades other than 4, 8, and 11 will meet or exceed grade level achievement standards on grade level report cards and/or local assessment measures Migrant students in grades 9-12 will achieve high school credits to meet graduation or GED requirements on their target graduation date. *Note the Migrant Teacher Handbook provides guidance for migrant education in Maine and will be adhered to if LEA utilizes Title IC funds. 3. Project Budget: Use whole dollars only (no cents) Salaries & Benefits (100, 200)Contracts (300-500)Travel (500)Supp/ Books (600)Equipment (700)Capital Equipment (780)Other (890)Project Total [Copy to Pg. E-10 Row (b)] FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       NCLB Project Sheet Migrant Education-Title IC Unit  FORMTEXT       Project Title Home/School Coordinator 1. Purpose: The purpose of the Migrant Program is to provide services to eligible migrant students so they can achieve the Maine s Learning Results at the same rate as non-migrant students. 2. Project Description:  FORMTEXT       3. Outcome/Performance Indicators: Migrant students will attend school 96% of the time they are enrolled. Migrant families will receive one home visit and sign a negotiated Home Visit/Parent Agreement. Parent Advisory Council (PAC) meetings and parent training sessions will be held two times per year. Services to migrant students and families will be identified and provided by migrant staff and other school and community agencies.  FORMTEXT       *Note the Migrant Teacher Handbook provides guidance for migrant education in Maine and will be adhered to if LEA utilizes Title IC funds. 3. Project Budget: Use whole dollars only (no cents) Salaries & Benefits (100, 200)Contracts (300-500)Travel (500)Supp/ Books (600)Equipment (700)Capital Equipment (780)Other (890)Project Total [Copy to Pg. E-10 Row (b)] FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       NCLB Project Sheet Migrant Education-Title IC Unit  FORMTEXT       Project Title Identification and Recruiting 1. Purpose: The purpose of the Migrant Program is to provide services to eligible migrant students so they can achieve the Maines Learning Results at the same rate as non-migrant students. 2. Project Description:  FORMTEXT       3. Outcome/Performance Indicators: K-12 migrant students will be identified for  priority for services and needed services will be provided for these students first. Migrant Program eligibility guidelines will be used to identify and recruit new families. * Note: The Migrant Teacher Handbook provides guidance for migrant education in Maine and will be adhered to if LEA utilizes Title IC funds 3. Project Budget: Use whole dollars only (no cents) Salaries & Benefits (100, 200)Contracts (300-500)Travel (500)Supp/ Books (600)Equipment (700)Capital Equipment (780)Other (890)Project Total [Copy to Pg. E-10 Row (b)] FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       NCLB Project Sheet Migrant Education-Title IC Unit  FORMTEXT       Project Title Summer Programming 1. Purpose: The purpose of the Migrant Program is to provide services to eligible migrant students so they can achieve the Maine s Learning Results at the same rate as non-migrant students. 2. Project Description:  FORMTEXT       3. Outcome/Performance Indicators: All eligible migrant students will have the opportunity to participate in a summer program with a reading/language arts, writing, and/or mathematics academic component. All migrant students participating in summer programs will meet their contract objectives. *Note: The Migrant Teacher Handbook provides guidance for migrant education in Maine and will be adhered to if LEA utilizes Title IC funds. 3. Project Budget: Use whole dollars only (no cents) Salaries & Benefits (100, 200)Contracts (300-500)Travel (500)Supp/ Books (600)Equipment (700)Capital Equipment (780)Other (890)Project Total [Copy to Pg. E-10 Row (b)] FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       NCLB Project Sheet Migrant Education-Title IC Unit  FORMTEXT       1. Project Information Place " If New HireName of EmployeePosition*School If position is split among schools, list the % of time spent at each schoolGrade SpanTitle 1C Hours Per Week# of anticipated Eligible Students as of June 1 FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       *Full-time Equivalent NCLB Project Sheet Teacher Quality - TITLE IIA - PD Please use a separate sheet for each of your professional development Title IIA funded projects. This form may also be used for funds (up to 4%) to administer the Title IIA program. Unit  FORMTEXT       Project #  FORMTEXT      Title  FORMTEXT       If a non-public school project, provide non-public School Name  FORMTEXT       1. Need: What need(s) based on the local professional development needs assessment will be addressed by this project?  FORMTEXT       2. Goals: What specific professional development goal(s) has been established to meet this need(s)?  FORMTEXT       3. Project Description: Describe the activities/strategies to be undertaken to achieve this professional development goal(s).  FORMTEXT       4. Outcomes/Performance Indicators: If this goal is achieved, what changes in teacher effectiveness, knowledge and skills do you expect to occur and how will you measure these changes?  FORMTEXT       5. Project Budget: Use whole dollars only (no cents) Salaries & Benefits (100, 200)Contracts (300-500)Travel (500)Supp/ Books (600)Equipment (700)Capital Equipment (780)Other (890)Project Total ( [Copy to Pg. E-10 Row (b)] FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       ( If this is a REAP project, all reaped funds are listed on page G-3 Row (d) under the Title from which they were allocated with an  R after the amount. NCLB Project Sheet Teacher Quality - TITLE IIA-CSR Please use a separate sheet for each of your Title IIA funded projects for class size reduction. Unit  FORMTEXT       Project Title  FORMTEXT       1. Need: Describe the current class size situation. Grade LevelEnrollment without positionEnrollment with position FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT       2. Staffing: Federal regulations require that all positions funded with federal funds after the first day of the 2002-2003 school year meet the definition of  highly qualified . Please complete the form below for each position funded by Title IIA indicating the date of hire and whether or not the individual meets the definition for highly qualified. If the individual does not meet the definition for highly qualified attach a separate sheet describing the timeline and the steps to be taken to ensure that the person will meet the highly qualified standards as soon as possible. Date of HireMeets Highly Qualified requirementsPosition Title Name of Staff Member YesNo* FORMTEXT       FORMCHECKBOX   FORMCHECKBOX  FORMTEXT         FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       FORMTEXT       3. Anticipated Outcomes/Performance Indicators: Describe the expected impact on student achievement with this position.  FORMTEXT       4. Project Expenditures: Use whole dollars only (no cents) Salaries & Benefits (100, 200)Contracts (300-500)Travel (500)Supp/ Books (600)Equipment (700)Capital Equipment (780)Other (890)Project Total ( [Copy to Pg. E-10 Row (b)] FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       ( If this is a REAP project, all reaped funds are listed on page G-13 Row (d) under the Title from which they were allocated with an  R after the amount. Calculating Funds for Non-Public School Title IIA Unit  FORMTEXT       Contact Person Phone  FORMTEXT       E-mail  FORMTEXT       STEP I: Complete Lines 1-4 below. Line 1 FORMTEXT      : Enter the Title IIA Teacher Quality Allocation for 2004-2005. Line 2 FORMTEXT      : Enter the amounts of any funds being transferred into (+) or out (-) of Title IIA. These amounts are listed in Rows (b) and (c) on page E-9 of the 2004-2005 NCLB Application. Line 3 FORMTEXT      : Enter the amount of Title IIA funds that will be used for administration of Title IIA funds (up to 4%) and/or Class Size Reduction (CSR) in the NCLB 2004-2005 application. Line 4 FORMTEXT       Enter the amount calculated: (Line 1) + or  (Line 2)  (Line 3). This is the amount of 2004-2005 Title IIA funds that will be used by public and non-public schools for professional development. STEP 2: Check each E-4 page of the NCLB Application to determine which non-public schools wish to participate in Title IIA. List those schools in Column A of the table below. STEP 3: Enter the hold harmless amount from Appendix A for each non-public school listed in Column B below. STEP 4: Enter the non-public school enrollment percent from Appendix A in Column C below. STEP 5: In Column D, enter the amount from Line 4 above. STEP 6: Calculate Column E by multiplying Column C by Column D. STEP 7: Compare Column B and Column E. Enter the largest of the amounts in column F. This is the amount that must be used for determining equitable professional development services to the non-public school. Column AColumn BColumn CColumn DColumn EColumn FNon-Public Schools Participating in Title IIANon-Public Hold Harmless Amount (from Appendix A)Non-public Enrollment Percent (from Appendix A)Title IIA PD Funds (from Line 4 above)Non-Public Amount based on Enrollment and Title IIA PD Funds (C * D)Non-Public Amount required for equitable PD services (Larger of B and E) FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       NCLB Project Sheet TITLE IID Please use a separate sheet for each of your Title IID funded projects. Duplicate project sheet as needed. Unit  FORMTEXT       Project Title  FORMTEXT       If non-public school project, provide non-public School Name  FORMTEXT       1. Project Description: (Include staff development information)  FORMTEXT       2. Outcomes/Performance Indicators: (A well written outcome is realistic, clear, specific and measurable) How will you know your project is successful?  FORMTEXT       3. Staff Development: A minimum of 25% of your total Education Technology funds must be used for technology-based staff development. Indicate how you plan to comply with the regulation.  FORMTEXT       4. Project Budget: Use whole dollars only (no cents) Salaries & Benefits (100, 200)Contracts (300-500)Travel (500)Supp/ Books (600)Equipment (700)Capital Equipment (780)Other (890)Project Total ( [Copy to Pg. E-10 Row (b)] FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       ( If this is a REAP-Flex project, see REAP-Flex Project Sheet (E-11). Do not copy this amount to Pg. E-10. NCLB Project Information Sheet TITLE III Project Description: Title III grants will be available to a small number of Maine school districts. These are schools or schools in consortia that enroll approximately 80 limited English proficient students. Those districts already know of their eligibility for these funds. Districts expecting a Title III application and who may not have received one yet may do so by contacting: Dr. Barney Brub Maine Department of Education 23 State House Station Augusta, ME 04333-0023 Telephone: 624-6788 E-mail:  HYPERLINK "mailto:barney.berube@maine.gov" barney.berube@maine.gov Note: Title III applications should be sent directly to the above address. It should not be affixed to the consolidated application. Application Development Sheet Safe & Drug Free Schools & Communities Program Title IV-A SEE PAGE E-28 FOR DETAILED GUIDANCE AND EXAMPLES FOR COMPLETING THIS PAGE. LEA Name:  FORMTEXT       A. CONSULTANTS: Identify, by name and title, all persons who serve as consultants to your Title IV-A, Safe & Drug-Free Schools & Communities Program.  FORMTEXT       B. CONSULTATION PROCESS: Describe the consultation process as it applies to your Safe & Drug-Free Schools and Communities Program. Also, describe how the LEA will publicly report its progress toward attainment of performance measures.  FORMTEXT       C. NEEDS ASSESSMENT: List the specific local objective data that were reviewed and analyzed as part of your substance use/violence needs assessment.  FORMTEXT       D. RISK FACTORS: Identify at least three significant risk factors that exist in your community.  FORMTEXT       E. PROTECTIVE FACTORS: Identify at least three significant protective factors that exist in your community.  FORMTEXT       F. PRIORITY ISSUES: As a result of the assessment of local objective data and community risk & protective factors, identify the priority issues that your LEA will address during this school year.  FORMTEXT       G. COMPREHENSIVE K-12 SUBSTANCE USE AND VIOLENCE PREVENTION PROGRAM: By grade level, or other appropriate grouping, list all (not just Title-IV A funded) programs, services, and activities that your LEA employs to promote safe and drug-free learning environments.  FORMTEXT       Project Sheet Safe & Drug Free Schools & Communities Program Title IV-A SEE PAGE E-29 FOR DETAILED GUIDANCE AND EXAMPLES FOR COMPLETING THIS PAGE. LEA Name: FORMTEXT       Title IV-A Project #  FORMTEXT       If this is a non-public school project, provide the name of the non-public school:  FORMTEXT       1. Priority Issue:  FORMTEXT       2. Strategy Selection: Strategy # 1:  FORMTEXT       (On the line above, enter the name of the "Model Program Strategy" or "Other Allowable Strategy") Strategy # 1 Budget: Salaries & Benefits: $  FORMTEXT       Contracts: $  FORMTEXT       Travel: $  FORMTEXT       Supplies/Books: $  FORMTEXT       Security Equip: $  FORMTEXT       Other: $  FORMTEXT       STRATEGY #1 TOTAL: $  FORMTEXT       Strategy # 2: (If applicable)  FORMTEXT       (On the line above, enter the name of the "Model Program Strategy" or "Other Allowable Strategy") Strategy # 2 Budget: Salaries & Benefits: $  FORMTEXT       Contracts: $  FORMTEXT       Travel: $  FORMTEXT       Supplies/Books: $  FORMTEXT       Security Equip: $  FORMTEXT       Other: $  FORMTEXT       STRATEGY #2 TOTAL: $  FORMTEXT       Strategy # 3: (If applicable)  FORMTEXT       (On the line above, enter the name of the "Model Program Strategy" or "Other Allowable Strategy") Strategy # 2Budget: Salaries & Benefits: $  FORMTEXT       Contracts: $  FORMTEXT       Travel: $  FORMTEXT       Supplies/Books: $  FORMTEXT       Security Equip: $  FORMTEXT       Other: $  FORMTEXT       STRATEGY #3 TOTAL: $  FORMTEXT        3. Strategy Justification:  FORMTEXT       4. Strategy Implementation:  FORMTEXT       5. Anticipated Outcomes: (Attitude / Behavior Change)  FORMTEXT       6. Overall Project Budget: (This budget should reflect the combined strategy budget figures that you provided in section # 2.) Salaries & Benefits (100, 200)Contracts (300-500)Travel (500)Supp/ Books (600)Security Equipment (20% of the adjusted Title IV-A allocation is max amount allowed.) (700)Capital Equipment (780) Not allowable under Title IV-AOther (890)Project Total ( Copy to Pg. E-10 Row (b) FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      XXXXXX FORMTEXT       FORMTEXT      ( If this is a REAP-Flex project, see REAP-Flex Sheet E-11. Do not copy this amount to Pg. E-10. Application Development Sheet Safe & Drug Free Schools & Communities Program Title IV-A GUIDANCE & EXAMPLES FOR COMPLETING PAGE E-26. A. CONSULTANTS: Identify, by name and title, all persons who serve as consultants to your Title IV-A, Safe & Drug-Free Schools & Communities Program. Guidance: Cite all persons who serve as consultants such as teachers and other staff; parents; students; private school representatives if included in the LEA; community-based organization representatives; medical, mental health, law enforcement professionals; and others with relevant and demonstrated expertise in drug and violence prevention activities. Signatures are no longer required. B. CONSULTATION PROCESS: Describe the consultation process as it applies to your Safe & Drug-Free Schools and Communities Program and state the methods that the LEA will employ to publicly report progress toward attainment of performance measures. (Board meetings, newsletters, parent forums, websites, local media, etc.) Guidance: Cite the steps that are taken to ensure meaningful and ongoing consultation. Cite key contributions of persons consulted, meeting dates, meeting purposes, etc. Example: The consultation group met four times during the past year. At the June 3rd meeting we reviewed recent changes in Title IV-A application procedures and regulations. On June 24th the group met again and examined the results of the recent MYDAUS survey and the Incidence of Prohibited Behavior (IPB) data, reviewed the plan for the previous year, and developed a plan and budget for the upcoming year. At an August 29th meeting the group determined who would provide oversight of the programs and activities supported by Title IV-A funds. On March 18th the group met to review progress to date. Student consultants were present at each meeting and freely shared their thoughts and perceptions on how to make our programs more relevant to student needs. C. NEEDS ASSESSMENT: List the specific local objective data that were reviewed and analyzed as part of your substance use/violence needs assessment. Guidance: Cite local data types such as Maine Youth Drug & Alcohol Use Survey (MYDAUS); School Discipline Data; Attendance Data; Suspension/Expulsion Data; Student/Faculty Survey Results; IPB Data; Law Enforcement Data; Counselor Referral Data; SAT Data; Hospital Data. D. RISK FACTORS: Identify at least three significant risk factors that exist in your community. Guidance: Risk Factors are those elements in a young person's environment that increase the likelihood of engaging in negative and antisocial behaviors. Community risk factors might include transitions and mobility, community laws and norms favorable to drug use, firearms and crime, availability of drugs and firearms; Family risk factors might include poor family management, family conflict; School risk factors might include academic failure, lack of commitment to school, school disorganization; Individual/peer-group risk factors might include early initiation of problem behavior, friends who engage in problem behaviors, favorable attitudes toward problem behaviors. E. PROTECTIVE FACTORS: Identify at least three significant protective factors that exist in your community. Guidance: Protective Factors are those factors that, when present in a young person's developmental environment, serve as a buffer between them and the development of health and behavior problems. Examples of key protective factors might include: Individual characteristics of intelligence, resilience, social competence; Bonding to family, peers, school, and neighborhood/community; Healthy beliefs and clear standards communicated to young people through their families, schools, communities, and peer groups. F. PRIORITY ISSUES: As a result of the assessment of local objective data and community risk & protective factors, identify the priority issues that your LEA will address during this school year. Guidance: Cite priority issues in a manner similar to the following examples: Priority Issue Example # 1: Target the high number of physical aggression incidents on the playground at XYZ Elementary School. 102 (40%) of the 256 total incidents referred to the site disciplinarian during the past school year involved some degree of physical aggression on the playground. Priority Issue Example # 2: Target the onset of alcohol use by middle school students. 17% of students in grade 8 (22 of 128) indicated on the most recent MYDAUS survey that they had used alcohol in the past 30 days. G. COMPREHENSIVE K-12 SUBSTANCE USE AND VIOLENCE PREVENTION PROGRAM: Guidance: By grade level, or other appropriate grouping, list all (not just Title-IV A funded) programs, services, and activities that your LEA employs to promote safe and drug-free learning environments. Project Sheet Safe & Drug Free Schools & Communities Program Title IV-A GUIDANCE & EXAMPLES FOR COMPLETING PAGE E-27. This form is used to develop only TITLE IV-A FUNDED substance use or violence prevention projects. 1. Priority Issue: Guidance: From Section F of the Application Development sheet, cite the identified priority issue that this Title IV-A funded project will address. Include local objective baseline data that links to the identified priority issue. Support baseline percentages with "hard" numbers. Example 1: Target the high number of physical aggression incidents on the playground at XYZ Elementary School. 40% of the total incidents (102 of 256) referred to the site disciplinarian during the past school year involved some degree of physical aggression on the playground. 2. Strategy Selection: Guidance: Use the Model Prevention Strategies and/or Other Allowable Prevention Strategies lists (in the Title IV-A section of the "Guidance for the Consolidated Application" packet) to select the Title IV-A funded strategy(ies) that will be employed to address the identified priority issue. Then develop a budget for each selected strategy. (In Section # 6 you will combine the strategy budget figures to reflect an "overall" project budget.) If you do not request to use your Title IV-A funds on a Model Prevention Strategy, your only other option is to request funding for an Other Allowable Prevention Strategy which requires a waiver to be granted by the state.) Model Prevention Strategies: Model prevention strategies are nationally recognized, research-based programs that have been subjected to rigorous review and meet high standards. When implemented with fidelity, these model programs have proven to be effective in reducing violence and illegal drug use. Examples include LifeSkills, Project Alert, Reconnecting Youth, Second Step, Project Northland, etc. Other Allowable Prevention Strategies: The state may grant a waiver for the use of non-model prevention strategies if the applicant can demonstrate adherence to the Principles of Effectiveness in selecting the strategy and that the strategy to be employed has a substantial likelihood of success in changing behaviors and/or attitudes relative to substance use and/or violence. Examples of Other Allowable Prevention Strategy categories include Conflict Resolution Programs, Student Prevention Activities, Student Assistance Programs, Prejudice / Intolerance Programs, and School Security Equipment. (The applicant is no longer required to submit a separate waiver request form. Final determination as to whether a waiver is granted for this type of project will be based solely on the quality and content of the information provided on the Title IV-A application forms.) 3. Strategy Justification: Guidance: FOR EACH SELECTED STRATEGY PREVIOUSLY FUNDED BY TITLE IV-A: Cite local data from the "actual outcomes" section of your performance report that will support a conclusion that continued funding of the strategy is warranted. Guidance: FOR EACH SELECTED STRATEGY NOT PREVIOUSLY FUNDED BY TITLE IV-A: Cite research articles or other analysis that supports a conclusion that the selected strategy has a substantial likelihood of success in changing behaviors and/or attitudes relative to substance use and/or violence. 4. Strategy Implementation: Guidance: In this section provide additional detail on how each selected strategy will be implemented. (Identify the basic "who, what, where, when" components for each selected strategy.) Example 1, Model Prevention Strategy, LifeSkills: The LifeSkills Curriculum will be purchased this fall for implementation in Grades 5, 6 and 7. One teacher from each grade will attend a two-day training program on Life Skills and share materials and teaching strategies gleaned from the training with colleagues teaching in that grade level. All teachers involved in the project will work with the district evaluation consultant in designing an assessment strategy and participate in data collection. Example 2, Other Allowable Prevention Strategy, Student Prevention Activities: In early October, all seventh graders will attend the Camp Kieve Leadership Decisions Institute. Students will work on team building, communication, trust, and facing and overcoming challenges. ATOD awareness and other health and violence prevention components are included as a primary focus of the experience. Throughout the year, Grade 7 teachers will reinforce the concepts, attitudes, and skills learned at Camp Kieve. Students and staff will participate in evaluating the impact of the program. 5. Anticipated Outcomes: (Attitude / Behavior Change) Guidance: In this section establish measurable outcome(s) for this project. Outcomes must be measurable in terms of changing attitudes and/or behaviors relative to substance use and/or violence and must include relevant baseline data. Outcomes that measure only greater awareness/knowledge or increased attendance/participation are not acceptable. Examples of acceptable attitude/behavior change outcome statements: To reduce the prevalence of bullying in grades 5-8 by 50%. (From 60 to 30 reported incidents.) To reduce the number of 7th grade students indicating that they might be willing to take illegal drugs when they are in high school by 20%. (From 180 to 144.) To increase the number of high school students reporting that they always feel safe at school by 10%. (From 684 to 760 students.) 80% of high school students referred to the substance abuse counselor for tobacco use will quit or significantly reduce usage. 10 students were referred last year and 80% (8) were successful in quitting or significantly reducing usage. We anticipate 8-15 referrals this year. Guidance (continued): Cite the instrument(s) that will be used to track the outcome data and who will be responsible for tracking the data. (Types of instruments that might be used include MYDAUS Data; School Discipline Data; Attendance Data; Suspension/Expulsion Data; Student/Faculty Survey Results; Law Enforcement Data; Counselor Referral Data; SAT Data; Hospital Data.) 6. Overall Project Budget: Guidance: This budget should reflect the combined strategy budget figures that you provided in section # 2. NCLB Project Sheet TITLE V Please use a separate project sheet for each Title V Innovative Education project. Unit  FORMTEXT       Project Title  FORMTEXT       If non-public school project, provide non-public School Name  FORMTEXT       1. NCLB Goal(s) Addressed (check all that apply):  FORMCHECKBOX  1. By 2013-2014, all students will reach high standards, at a minimum attaining proficiency or better in reading/language arts and mathematics.  FORMCHECKBOX  2. All limited English proficient students will become proficient in English and reach high academic standards, at a minimum attaining proficiency or better in reading/language arts and mathematics.   FORMCHECKBOX  3. By 2005-2006, all students will be taught by highly qualified teachers.  FORMCHECKBOX  4. All students will be educated in learning environments that are safe, drug free, and conducive to learning.  FORMCHECKBOX  5. All students will graduate from high school. 2. Project Description (What, where and why):  FORMTEXT       3. How will this project contribute towards (a) improving student achievement or (b) improving the quality of education for students?  FORMTEXT       4. If a staff development project: Provide information that supports the concept that this project is part of a high quality, sustained, intensive staff development program and not a short-term workshop.  FORMTEXT       ------------------------------------------------------------------------------------------------------------------------------------------ NOTE: Outcomes / Performance Indicators: An outcome report, backed by supporting data, is to be provided at the end of year in the performance report on either or both of the two Title V targets. The targets are: 1. How did this project contribute towards improving student academic achievement? 2. How did this project improve the quality of education for students? Project coordinators should be gathering evidence of the impact of their project during its duration. 5. Impact Data: Fill in the estimated impact numbers for this project. Students K-5Students 6-8Students 9-12Staff (only if staff development project)# Of Schools ParticipatingPublic (P) or Non-Public (N) Project FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       6. Project Budget: Use whole dollars only (no cents) Salaries & Benefits (100, 200)Contracts (300-500)Travel (500)Supp/ Books (600)Equipment (700)Capital Equipment (780)Other (890)Project Total ( [Copy to Pg. E-10 Row (b)] FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      ( If this is a REAP-Flex project, see REAP-Flex Project Sheet (E-11). Do not copy this amount to Pg. E-10 PAGE  FY05 ( See instructions and guidance at  HYPERLINK "http://www.state.me.us/education/nclb" www.state.me.us/education/nclb ( E- PAGE 3 FY05 ( See instructions and guidance at  HYPERLINK "http://www.state.me.us/education/nclb" www.state.me.us/education/nclb ( E- PAGE 5 FY05 ( See instructions and guidance at  HYPERLINK "http://www.state.me.us/education/nclb" www.state.me.us/education/nclb ( E- PAGE 7 FY05 ( See instruction and guidance at  HYPERLINK "http://www.state.me.us/education/nclb" www.state.me.us/education/nclb ( E- PAGE 8 FY05 ( See instructions and guidance at  HYPERLINK "http://www.state.me.us/education/nclb" www.state.me.us/education/nclb ( E- PAGE 10 FY05 ( See instructions and guidance at  HYPERLINK "http://www.state.me.us/education/nclb" www.state.me.us/education/nclb ( E- PAGE 24 FY05 ( See instructions and guidance at  HYPERLINK "http://www.state.me.us/education/nclb" www.state.me.us/education/nclb ( E- PAGE 30  For your convenience, the forms are available in MSWord2000 and html format on the website at www.state.me.us/education/nclb. 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