21st CCLC 2006-07 Annual Performance Report: Paper Forms for Grantees

21st CCLC 2006-07
Annual Performance Report:

Paper Forms for Grantees

Paperwork Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information collection is estimated to average ____ hours (or minutes) per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4700. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: 21stCCLC Program, AITQ, Office of Elementary and Secondary Education, U.S. Department of Education, 400 Maryland Avenue, S.W., LBJ/FB-6, 3W211, Washington, D.C. 20202-6200.

March 2007

U.S. Department of Education
21st Century Community Learning Centers (21st CCLC)

1120 East Diehl Road, Suite 200

Naperville, IL 60563-1486

800-356-2735  630-649-6500

www.learningpt.org

Copyright © 2006 Learning Point Associates, sponsored under government Analytic Support for Evaluation and Program Monitoring, OMB number 1810-0668. All rights reserved.

 

This work was originally produced in whole or in part with funds from the U.S. Department of Education under Analytic Support for Evaluation and Program Monitoring, OMB number 1810-0668. The content does not necessarily reflect the position or policy of the Department of Education, nor does mention or visual representation of trade names, commercial products, or organizations imply endorsement by the federal government.

Contents

Introduction 1

Grantee-Level Information 1

Objectives 1

Partners 3

Centers 4

Comments 5

Confirmation Page 6

Introduction

This is a paper version of the grantee-level forms available on the Profile and Performance Information Collection System (PPICS) Web site at http://ppics.learningpt.org/ppics/.
Any questions may be directed to the 21st CCLC helpline at 866-356-2711 or [email protected]. Completed forms may be mailed to the following address:

21st CCLC PPICS APR Forms c/o Neil Naftzger

Learning Point Associates

1120 East Diehl Road, Suite 200

Naperville, IL 60563

Remember also to include completed center-level forms for each of your centers. Each center’s forms should be stapled or clipped so that all of its information remains together. Please provide all information to the best of your ability:

Grantee-Level Information

Grantee Name: ________________________________________________

State ID Number ________________________________________________

Award Month/Year ________________________ ________

Grantee Address: ________________________________________________

City, State, ZIP ________________________ ________ __________

Objectives

On the next page, please list the objectives that you identified in filling out the grantee profile at http://ppics.learningpt.org/ppics/. (If you didn’t fill out a grantee profile, please list the objectives identified in your proposal for funding.) In the columns to the right, please indicate your progress toward this objective by checking only one (1) of the following categories:

M = Met the stated objective

P = Did not meet but progressed toward the stated objective

NP = Did not meet and no progress was made toward the stated objective

U = Unable to measure progress on the stated objective

R = Revised the stated objective

D = Dropped the stated objective entirely

NA = Objective not associated with the reporting period

Add additional sheets if necessary.

Objective	M	P	NP	U	R	D	NA
SAMPLE Improve reading scores for regular attendees on state test by an average of five points.		X

_ _______________________________ ________________________________

Grantee Name State Education Agency

Objective	M	P	NP	U	R	D	NA

Partners

________________________________ ________________________________

Grantee Name State Education Agency

Please fill out the information below for each partner or subcontractor you listed on your grantee profile or used during the reporting period. Print out (or photocopy) and attach additional sheets as necessary.

Partner Name: ____________________________________________________

Was this partner active during the reporting period? Yes No

Did this partner serve as a
subcontractor during the reporting period? Yes No

Estimated monetary value of contributions made
by the partner during the reporting period: _____________________

Estimated monetary value of the subcontract
held by the partner during the reporting period: _____________________

Please indicate how this partner contributed to the project during the reporting period
(choose all that apply):

Programming/Activity-Related Services

Goods/Materials

Volunteer Staffing

Paid Staffing

Evaluation Services

Funding/Raising Funds

Other:

_____________________________________________________

_____________________________________________________

_____________________________________________________

Centers

________________________________ ________________________________

Grantee Name State Education Agency

Please list below each center providing services under this grant and whether it was active during the reporting period. Attach additional sheets if necessary. For each active center, fill out a separate form for center-level information.

_____________________________________ Active Inactive

_____________________________________ Active Inactive

_____________________________________ Active Inactive

_____________________________________ Active Inactive

_____________________________________ Active Inactive

_____________________________________ Active Inactive

_____________________________________ Active Inactive

_____________________________________ Active Inactive

_____________________________________ Active Inactive

_____________________________________ Active Inactive

Comments

________________________________ ________________________________

Grantee Name State Education Agency

If you have not completed one or more of the required sections of the APR, please give a description and explanation below. You may also provide any other information you wish to include. Please be sure to state the name(s) of the section(s) or specific question(s) to which you are referring. You may attach additional sheets as needed.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Confirmation Page

________________________________

Grantee Name

________________________________ ________________________________

Grantee State ID Number (if applicable) State Education Agency

Please indicate below which APR forms you have completed. All forms are required of all grantees. Please check over the associated forms to ensure that you have included all information. If you have not completed any required section, please give an explanation for the omission on page 5 (Comments) and write “see comments” next to the section title below. Under “Center-Level Forms,” please only mark the section as complete if you have included fully complete forms for that section from all of your centers.

Grantee-Level Forms

__________ Objectives (pages 1 and 2)

__________ Partners (page 3)

__________ Centers (page 4)

Center-Level Forms

__________ All standard categories

__________ All required impact categories
(as determined by state education agency)

I hereby state that all the information that I have provided is complete and accurate to the best of my knowledge.

________________________________

Signature