i3 Application

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Office of Innovation and Improvement

i3 Applicant Information Sheet

FY 2011

Instructions: Eligible applicants must complete and submit this information sheet with each application submitted. Completing this sheet will assist ED staff in assessing the needs of the i3 competition and provide staff with a better sense of the applicant pool.

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Who is the Eligible Applicant? (Please select from the drop down menu)

Are you the lead applicant on this grant? Yes No

Have you applied for more than one i3 grant? Yes No

Applicant Name:     

PR Award Number:      

(Number assigned upon submission of application ex:U396XXXXXXX)

Project Title:      

Lead Applicant City/State:      

Total number of students served by the grant:      

Student grade levels served by the grant:

Birth-Pre-K	Kindergarten	1	2	3
4	5	6	7	8
9	10	11	12	Post-Secondary

Implementation Sites:      City       State (Use two letter state abbreviation)

      City       State

      City       State

      City       State

      City       State

      City       State

      City       State

      City       State

      City       State

      City       State

If you have more than 10 implementation sites, please list them here with a semicolon separating each location:

     

Type of Grant Requested:			Length of Requested Grant Award:
Select the ONE Absolute Priority that you are addressing in your application.
Select up to two Competitive Preference Priorities (CPP) that you are addressing in your application. Note: Applicants may choose to address any number of the optional CPPs in their application but they will only be scored against two.
CPP 5: Innovations for Improving Early Learning Outcomes (zero or one point)	CPP 6: Innovations that Support College Access and Success (zero or one point)	CPP 7: Innovations to Address the Unique Learning Needs of Students with Disabilities and Limited English Proficient Students (zero or one point)	CPP 8: Innovations that Serve Schools in Rural LEAs (up to two points)	CPP 9: Improving Productivity (zero or one point)	CPP10: Technology (zero or one point)

Project Description:

In 2000 characters or less, please provide a brief description of the project you wish to propose. Be sure to include a summary of project objectives and expected outcomes, target number of students to be served in the project, and any special project features.

Project Partners: Please list all organizations partnering with this project and the amount of Federal funds requested for each as part of your overall budget.
Partner Name 1.      	State      	Budget Amount (numeric only) $      	Partner Type Official Other
2.      	     	$      	Official Other
3.      	     	$      	Official Other
4.      	     	$      	Official Other
5.      	     	$      	Official Other
6.      	     	$      	Official Other
7.      	     	$      	Official Other
8.      	     	$      	Official Other
9.      	     	$      	Official Other
10.       If	     	$      	Official Other
If If you have more than 10 partners, please list them here with a semicolon between each location:      
Private Sector Matching Requirement

Have you secured the private sector match? YES NO

If YES, list the organization(s) that are providing the matching funds.

1.      

2.      

3.      

4.      

5.      

6.      

7.      

8.      

9.      

10.      

If you have more than 10 entities helping to provide your match, please list them here with a semicolon separating each location:

     

Are you requesting a waiver for the private sector match? YES NO

If, YES, please attach the necessary justification under Appendix E at the time of submission.

Open Innovation Web Portal

The Open Innovation Web portal is an online tool that provides an opportunity for i3 applicants to further develop their ideas, identify potential partners, and secure matching funds. Applicants to the i3 Fund will not receive additional points or gain any formal advantage over those applicants who do not post their ideas and related information on the portal. The portal is operated in partnership with an outside organization.

If you are interested in learning more about the Open Innovation Web Portal, please visit innovation.ed.gov.

Would you like your information to be transferred to the Open Innovation Web Portal? YES NO

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Public 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. Public reporting burden for this collection of information is estimated to average 120 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefit (section 14007 of the American Recovery and Reinvestment Act of 2009. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or email [email protected] and reference the OMB Control Number 1855-0021. Note: If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Ms. Thelma Leenhouts, Investing in Innovation Fund, Office of Innovation and Improvement, U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, D.C. 20202.