Annual Performance Report for Partnership and State Projects under the GEAR UP Program (MS Word)

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										OMB Approval No.:  1840-0802
										Expiration Date       :  11/30/2011
             
				 U.S. DEPARTMENT OF EDUCATION				        
			
COLLEGE ACCESS CHALLENGE GRANT (CACG) PROGRAM 

Annual Performance Report 



	1.	  PR award Number: _________________________________________________________
		  (Located in block 5 of your grant award notification)

	2.	  Name of Grantee: ___________________________________________________________

	3.	  Address: __________________________________________________________________

	4.	  Name of Project Director/Contact Person: ________________________________________

	      Phone Number: ______________________	Fax: ______________________________
		  E-mail Address: _____________________________________________________________

	5.	  Name of Certifying Official: ___________________________________________________

	     Phone Number: _______________________	  E-mail Address: ______________________

	6. Report Period: _____________________________ to ________________________________
Month/Day/Year	Month/Day/Year

	We certify that to the best of our knowledge, the information reported herein is accurate and complete.


	_____________________________________	______________________________________
	Name of Project Director (Print)			Name of Certifying Official (Print)


	_____________________________________	______________________________________
	Signature and Date				Signature and Date





According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 1840-0802.  The time required to complete this information collection is estimated to average 30 hours per response, including the time to review instructions, search existing data sources, 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, DC 20202-4651.  If you have comments or concerns regarding the status of your individual submission of the form, write directly to: The CACG Program, U.S. Department of Education, 1990 K Street, N.W., Suite 6132, Washington, DC 20006-8524.										OMB Approval No.:  1840-NEW
								
INSTRUCTIONS:

College Access Challenge Grant (CACG) Program grant recipients are required to submit an Annual Performance Report (APR).  This report is used by the U.S. Department of Education (ED) to determine if projects funded under CACG are making substantial progress in meeting goals and objectives of the grant, as outlined in grant applications.  Please read the following instructions thoroughly to assist you in filling out the required report:   

The APR consists of a Cover Page and Two Parts:

The cover page along with Parts 1 and 2 of the APR must be e-mailed to [email protected] in Microsoft Word (.DOC).  The actual submission deadlines for Parts 1 and 2 are presented below.   Please send a coversheet, signed by both the project director and certifying official, within three days after electronic submission to the following address:

		College Access Challenge Grant Program
		U.S. Department of Education 
		Attn:  Karmon Simms-Coates 
		1990 K Street, NW, Suite 6132
		Washington, DC  20006

Ten days prior to the APR submission deadline, you may request permission to mail your APR by e-mailing [email protected].  In your request you must include the reason why you are unable to submit the APR electronically.  

Part 1 – includes the five sections listed below, which address the implementation of services and activities, project administration, and fiscal administration.  Part 1 of the APR must be filled out and submitted on or before _______.   Part I includes the following sections:

Section    I – Executive Summary
Section  II – Goals and Objectives
Section III – Administration
Section IV – Budgetary Information
Section  V – Services and Activities

Part 2 – collects data relating to CACG program performance measures.  In addition to Part 1, Grantees must fill out Part 2 of the APR only if they offered activities and services directly to students in secondary schools and/or provided scholarships to college students.  Part 2 must be submitted on or before  _____.

Grantees are expected to provide clear and concise responses to the APR questions.  Please write “Not Applicable” or “N/A” if a question does not pertain to your project.  Tables can be expanded to accommodate additional information, however, the contents of the report cannot be modified.






COLLEGE ACCESS CHALLENGE GRANT PROGRAM

PART 1 -- ANNUAL PERFORMANCE REPORT


SECTION I:  EXECUTIVE SUMMARY

1.  Please provide a brief description (1-2 pages) of the current status of your project.  Describe the 
     extent to which you have implemented all program activities and components planned for this 
     reporting period.  Highlight your major outcomes, successes, and challenges.



SECTION II:   GOALS AND OBJECTIVES

1.   Describe the progress that your project has made towards accomplishing the objectives of your 
      project for this reporting period as outlined in your grant application.  Please list your objectives in  
      the table below, and indicate what activities have taken place, the quantitative results of those
      activities, and actions required (what, if any, changes do you intend to make in response to the 
      results that you have seen).  You may extend this table on to another page as needed.

Objectives:  List the approved objectives from your grant application or work plan.  Where applicable, provide baseline data.
Activities:  List the activities that have been conducted to meet the objective.  
Results:  Has the objective been met?  If not, what progress have you made in reaching the objective?
Actions required:  Are you planning to make changes to the grant in response to the results?  
Example: 1. Enrollment in 7th grade pre-algebra will increase by 5% by next year.
Baseline:
Pre-algebra 7th grade -- 10%
               
Example:  After school tutoring program.
Example:  Enrollment changes from 2000/01 to 2001/02:  1) 7th grade pre-algebra: +65% 

Example:  Continue to identify students needing intervention services based on achievement scores.  Add science component to after school tutoring program.
1.





2.





3.





4.





5.





6.






2.  Describe any significant changes in your project design since the approval of your grant application 
     (e.g., changing from individual tutoring to group tutoring or placing more emphasis on enrichment  
     activities rather than remediation).  Do you anticipate making changes to your project design in the 
     coming year?  If so, please describe.  How have any changes or anticipated changes affected your 
     budget?  How will these changes impact quantitative outcomes and your ability to meet the 
     project’s goals.

SECTION III:  ADMINISTRATION 

1.  Organizational Structure/Capacity 
      
     a.   How does CACG fit into your organizational structure?

    b. What barriers or problems have you encountered in administering your grant, and how have you       
      addressed these problems?

     c.  Please list the names and titles of key personnel that are paid by CACG Federal or matching
          funds, and indicate the percentage of time each individual spends working on the grant.  If the 
          percentage of time is not available, you may indicate the number of hours in which the 
          individual was paid.

Name
Title
% of Time
Federal
Non-Federal
















    d. Describe any changes to key personnel of this grant that have come about over the past year, 
      including changes in titles, changes in percentage of time that a person is devoting to the 
      project, hiring of a key staff person, departure of a key staff person, or addition or elimination of 
      a position.  Discuss any significant changes to key personnel proposed or anticipated for the 
      coming year. (Please remember that a change in key personnel or the addition or elimination of  
      position(s) requires prior approval from the Department of Education.  To request a change, 
      please request an administrative action separate from this report.   Your response to question 
     1d. should be a  summary of approved and completed changes that have taken place during this 
     reporting period.) 

2.  Coordination 
 
    a. How did you coordinate CACG activities and services with other programs in your state that assist students in preparing for and graduating from postsecondary education?

3.  Sub-Grants 

     If sub-grants were issued to non-profit organizations, please answer the following questions: 

     a.  How many subgrants did you issue?
     b.  Briefly describe any changes that were made to the grant award-making process, from what 
          was outlined in your application.
     c.  Did you develop written guidelines for subgrantees to use in implementing grants?
     d.  How do you monitor the subgrants?




4.  Financial Aid 
     
    a. If your project has obligated funds for future distribution of scholarships, loan cancellation or 
            repayment, or interest rate reductions, please specify a) the purpose, b) the amount of funds that 
were obligated, c) whether the funds are Federal or matching contributions, and d) the place where funds are being held pending distribution (e.g., are the funds in a trust account?)
  



Purpose 

Amount Obligated
 Federal
     or 
Matching


Placement of Funds
1




2





    b. If any funds have been disbursed to students for scholarships, loan cancellation or repayment, or interest rate reductions, please specify a) the purpose, b) the amount of money disbursed, c) whether the funds are Federal or matching contributions, and d) the number of students who benefited.




Purpose 

Amount 
Disbursed
 Federal
     or 
Matching


Number of Students
1




2





    5. Certifications

Grant recipients must provide certification for the following two requirements.   Please indicate ‘yes’ (if the requirement was met) or ‘no’ (if the requirement was not met) by placing an “X” in the appropriate box.  

a.  Indirect Cost Rate Agreement  

           Requirement:  CACG grantees are required to have a current indirect cost rate agreement 
           that is approved by the Federal government in order to charge indirect costs
           to the grant.   

Yes
No
Certification


Indirect costs were charged to the grant only if there was a current indirect cost rate agreement.

           If this requirement has not been met, please explain below.






     b.  Maintenance of Effort

Requirement:  For any academic year beginning on or after July 1, 2008, States are required to expend amounts that are equal to or greater than:  1) the average amount provided for non-capital and non-direct research and development expenses or cross by the State to the public institutions during the five most recent academic years for which satisfactory data are available; and 2) the average amount provided for student financial aid for paying postsecondary education costs by the State to private institutions during the most recent academic years for which satisfactory data are available.  

Yes
No
Certification


The level of effort pertaining to public higher education was met as outlined above.  
 


The level of effort pertaining to private higher education was met as outlined above.


     If this requirement has not been met, please explain below.
SECTION IV – BUDGETARY INFORMATION

1.  In the following table, please provide information about your actual and anticipated Federal 
     expenditures for the current budget period.  You do not need to fill in the shaded boxes, but please 
     indicate total amounts in line D for all columns.

Federal Budget Summary




Federal Funds Awarded  
Actual Federal
Expenditures for ? - ? of Current Budget Period

Anticipated Federal 
Expenditures for ?  –? of Current Budget Period 

Anticipated Carryover to Next Budget Period (if applicable)
    1. Salaries and Wages






    2. Employee Benefits






    3. Travel






    4. Materials & Supplies






    5. Consultants & Contracts





    6. Other





    A. Total Direct Costs:
(Lines 1 – 6)




    B. Total Indirect Costs:





    C. Equipment 





D.  *Scholarships/                    Tuition Assistance





D.  Total Costs (A+B+C+D)





* The scholarships/tuition assistance line item also includes loan cancellation, loan repayment, and interest rate reduction.  
2.   In the following table, provide information about your actual and anticipated non-Federal matching 
      contributions for the current budget period:

Non-Federal Budget Summary




Matching Contributions Proposed For Current Budget Period
(September-August)
Actual Matching Contributions for September-March of Current Budget Period
Anticipated Matching Contributions for April –August of Current Budget Period

Anticipated Carryover to Next Budget Period, if applicable
1. Salaries and Wages






2. Employee Benefits






3.Travel






4. Materials & Supplies






5. Consultants & Contracts





6. Other





A. Total Direct Costs:
(Lines 1 – 6)




B. Total Indirect Costs:





C. Equipment 





D. *Scholarships/ Tuition  Assistance





E. TOTAL COSTS
 (A+B+C+D)





*   The scholarships/tuition assistance line item also includes loan cancellation, loan repayment, and interest rate reduction.  

3.  Please fill out the table below representing “actual” federal and matching expenditures for the first 
     year.  If you are reporting on the first year of implementation, you do not need to fill out this table.  


Actual Federal Expenditures
Year 1
Actual Matching Contributions 
Year 1
1. Salaries and Wages


2. Employee Benefits


3. Travel


4. Materials & Supplies


5. Consultants & Contracts


6. Other


A. Total Direct Costs:
(Add lines 1-6)


B. Total Indirect Costs



C. Equipment Purchase


D.  *Scholarships/ 
Tuition Assistance


E. TOTAL COSTS
(A+B+C+D)



*   The scholarships/tuition assistance line item also includes loan cancellation, loan repayment, and interest rate reduction. 
4.  Please describe any changes made to your budget with respect to either Federal or matching funds.

5.  Please describe how you plan to expend any carryover funds.

    6. Please provide a list of matching sources, such as State appropriations, non-profit organizations,
      local government entities, institutions of higher education, other public or private organizations.  



Source
Amount Contributed
Briefly describe the type of contribution
  1



  2



  3



  4



  5



  6



  7



  8



  9



10



11



12



13



14



15




SECTION V:  SERVICES/ACTIVITIES

1.  Please enter the number of students who participated in CACG activities or received services. 

     Number of Students:  ________

2.  Services Provided to Students:  In the following table, place an “X” in the first column next to the 
     types of services or activities provided by your project with Federal or matching funds.  For each 
     type of service provided, indicate the number of students who received the service during the 
     reporting period. 

Place an “X” in this column if your project provides this type of service

Type of Service/Activities

Number of Students

Information for students and families (i.e., postsecondary education benefits, opportunities, planning, financial options, and college preparation)


Outreach activities


Assistance in completion of FAFSA or other financial reporting forms


Need-based grant aid 


Academic enrichment


Loan cancellation, repayment, or interest rate reduction


Other (please specify)


3.  Professional Development

     a.  Please enter the number of guidance counselors at middle and secondary schools, financial aid
          administrators, and/or college admissions counselors at an institution of higher education that 
          participated in professional development activities.


Category
Number of Participants
Middle or High School Counselors

Financial Aid Administrators

College Admissions Counselors


   b.  Please describe briefly the type of professional development activities that were implemented 
        (e.g., workshops and/or materials).
COLLEGE ACCESS CHALLENGE GRANT PROGRAM

PART 2 - ANNUAL PERFORMANCE REPORT


Grantees must fill out and submit Part 2 of the APR only if they offered activities and services directly to students in secondary schools and/or provided scholarships to college students.  Part 2 must be submitted on or before  ______.

1.  If your project offers activities and services directly to students in secondary schools: 
    
     a.  Please provide the number of high school seniors who received services as a result of the CACG 
          grant in the FY 200__ academic year.  Note:  If secondary school guidance counselors were 
          provided professional development in applying for federal student financial assistance, include   
          all of the high school seniors at the guidance counselors’ target school(s).

Number of Students 


     b.  Please provide the number of high school seniors who completed a Free Application for Federal 
          Student Aid (FAFSA) in the FY 200__ academic year.  
			
Number of Students 


2.  If your project has a scholarship (need-based grant aid) program, please provide the following
     information for the 200__  - 200 __ academic year .  

     a.	Number of high school seniors who were offered a CACG scholarship with Federal 
            funds.  ______

    b. Total cost of CACG scholarships offered to high school seniors with Federal funds for their first year of postsecondary education with federal funds.  _________

    c. Number of high school seniors who were offered a CACG scholarship with Federal funds and 
      enrolled in postsecondary education within one year of high school graduation.  _______

     d.  Number of college freshmen who received a CACG scholarship with Federal funds. ________