Non-SEA CSP Form and Instructions

Charter Schools Program (CSP) Grant Award Database

1855-0016 Copy of Non-SEA CSP Form 22815.xlsx

Charter Schools Program (CSP) Grant Award Database Forms

OMB: 1855-0016

Document [xlsx]
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Overview

Instruction Sheet
Non-SEA Part A
Non-SEA Part B


Sheet 1: Instruction Sheet

Charter Schools Program (CSP)
Office of Innovation and Improvement
U.S. Department of Education
CSP Data Collection Form - Non-SEA Grantees
Instructions
Purpose of Data Collection: The new data collection will collect CSP grant award information from grantees (State Educational Agencies (SEAs) and non-SEAs) to create a new database of data from current applicants receiving a CSP grants. The CSP Data Collection Form will allow the U.S Department of Education (ED) to monitor CSP grant performance and analyze data related to accountability for academic performance and financial integrity. The data collection will assist in carrying out the purpose of the Charter School Program Section 5201 of the ESEA, which is to expand the number of high quality charter schools and increase the national understanding of the charter school model.
For Direct Grant Recipients: Charter schools (or other organizations) receiving CSP grants directly from the U.S. Department of Education are asked to complete the following worksheet entitled "Data Collection Form: Direct Grant Recipients." This form has two parts. Part A asks for confirmation of CSP non-SEA award information. The school/grantee name, contact person, and PR/award number has already been entered in the form. If this information is incorrect, please contact the data collection administrators (see "Contact Information" below).

Part B asks for specific CSP award information that is not included in your Grant Award Notification (GAN). Please provide the following information for your non-SEA award: 1) the name and contact information for the charter school and LEA; 2) the charter school's management organization (CMO, EMO or freestanding); 3) the authorized public chartering agency; 4) the total amount of funding an applicant received to start a charter school, along with the amount of funds expended and the beginning and end date of the grant project period and budget periods; and 5) other charter school information (e.g., enrollment) as needed.
Form Submission: Completed CSP Data Collection Forms should be sent to [email protected]. In the subject heading please include "CSP Data Collection" followed by your school name. Please be sure to save a copy of the completed form for your own records.

If an electronic copy cannot be sent, please send a paper copy of the completed data collection form to the following address:
WestEd
Attn: CSP Data Collection
4665 Lampson Ave.
Los Alamitos, CA 90720
Please be sure to make a copy of the completed form for your own records.
Contact Information: If you have any questions or concerns regarding the completion of the data collection form, please contact WestEd. You can email us at [email protected], or call toll-free 866-902-4887.
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 1855-0016. The time required to complete this information collection is estimated to average 127 hours 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. 20202-4537. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: U.S. Department of Education, Office of Innovation and Improvement 400 Maryland Avenue, S.W., LBJ-4W227, Washington D.C. 20202-2800.
OMB Number: 1855-0016 Approval Expires 2/28/2015

Sheet 2: Non-SEA Part A

Charter Schools Program
Office of Innovation and Improvement
U.S. Department of Education
Data Collection Form: Non-SEAs
Part A
School:
School Contact Person:
Title of Contact Person:

PR/Award #:
Project Period Begin Date:
Project Period End Date:


Breakdown of Obligated Funds per Fiscal Year

Grant Award Amount
Supplemental Award Amount
Administrative Expenditures
FY 2011





FY 2012





FY 2013





FY 2014





Total Award Amount Obligated: $0
Comments? If any of the above information is incorrect, or if you need to provide any additional information regarding your CSP grant, please use the box below. You may also direct comments to us at [email protected], or call toll-free 866-902-4887.



Please turn to Part B to provide specific data for your grant
OMB Number: 1855-0016 Approval Expires 2/28/2015

Sheet 3: Non-SEA Part B

Data Collection Form: Non-SEAs (continued)
Part B: CSP Grant Award Information
Part B asks for specific CSP award information that is not included in your Grant Award Notification (GAN). Please provide the following information for your non-SEA award: 1) the full name and contact information for the charter school (and charter developer, if different than the charter school); 2) The total amount of funding an applicant received to start a charter school; 3) the beginning and end date of the grant project period and budget periods; and 4) other charter school information as needed.
1) Charter School Contact Information
Charter School Name and Contact Information Charter School Management Organization
Charter school name
Management Organization Type

School NCES ID
Management Organization Name

School mailing address
Management Organization address

address line 1:
address line 1:

address line 2:
address line 2:

city:
city:

state:
state:

zipcode:
zipcode:

LEA Information Authorized Public Chartering Agency
LEA name
Authorizer Type (choose one)

LEA NCES ID
Authorizer Name

LEA mailing address Authorizer mailing address

address line 1:
address line 1:

address line 2:
address line 2:

city:
city:

state:
state:

zipcode:
zipcode:

Does the charter school act as its own LEA?


Is it an LEA with only charter schools?

2) Grant Award and Expenditures Information

Please provide the breakdown of funds obligated to this grantee from each Federal Fiscal Year and the amount of funds expended. The total amount obligated across one or more years should equal the Total Award Amount provided on the left.
Project Period Begin Date

Project Period End Date

Total Grant Award Amount Obligated: $


In addition to providing the breakdown of funds obligated, please list the budget period for the time funds were obligated, and whether the awards were used for preplanning, planning, implementation or dissemination purposes.





FY 2014 FY 2013 FY 2012 FY 2011
Totals
Dollar amount of grant award $ $ $ $ $0.00
Total amount expended to date $ $ $ $ $0.00
Anticipated expenditures through end of FY $ $ $ $ $0.00
Beginning date of grant budget period mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy
$0.00
End date of grant budget period mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy
The remainder above is the carryover amount
Type of grant (choose one)





3) Charter School Operation
School year in which the school first enrolled students



School enrollment (if not opened, enter "0")
Number of students on waitlist to enroll each year (if not opened, enter "NA")

School enrollment and waitlist figures in 2006-07



School enrollment and waitlist figures in 2007-08


School enrollment and waitlist figures in 2008-09


School enrollment and waitlist figures in 2009-10


School enrollment and waitlist figures in 2010-11


School enrollment and waitlist figures in 2011-12


School enrollment and waitlist figures in 2012-13


School enrollment and waitlist figures in 2013-14


School enrollment and waitlist figures in 2014-15


Comments? If you need to provide any additional information regarding this CSP subgrant, please use the box below. You may also direct comments to us at [email protected], or call toll-free 866-902-4887.




Thank you very much for your cooperation.
OMB Number: 1855-0016 Approval Expires 2/28/2015
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