CSP Collection Form

---

Overview

Instruction Sheet
Part A-CSP Grant Award
Part B-CSP Schools Funded
Summary Sheet

---

Sheet 1: Instruction Sheet

Charter Schools Program (CSP)
Office of Innovation and Improvement
U.S. Department of Education
CSP Data Collection Form - Replication and Expansion (R&E) for High-Quality Charter Schools Grantees
Instructions
Purpose of Data Collection:										The new data collection will collect grant award information from grantees funded under the Replication and Expansion for High-Quality Charter Schools competition. 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. It will also allow the CSP to track the number of schools receiving financial support under this competition. 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 Grantees:										The CSP Data Collection Form has two parts:
										Part A asks for CSP grantee award information. The name, the contact person, and the contact person's department has already been entered in the form. If this information is incorrect, please contact the data collection administrators (see "Contact Information" below). In the gray boxes, please enter the number of schools for each Federal Fiscal Year that are still receiving CSP funds within the grantee's project period. Keep in mind that your Grant Award Notification (GAN) provides the beginning and end date for your current project period.
										Part B asks for CSP school award information. In all, grantees will provide the following information for each school receiving CSP funds: 1) the name and contact information for the charter school and LEA; 2) the authorized public chartering agency; 3) the total amount of funding an applicant received to replicate or expand a charter school, along with the beginning and end date of when funds were received; 4) the grades served and number of available seats per school; and 5) other charter school information (e.g., enrollment) as needed.
Form Submission:										The completed CSP Data Collection Form should be sent to [email protected]. In the subject heading please include "CSP Data Collection" followed by your organization's 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 CSP 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 CSP 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 5/31/2018

---

Sheet 2: Part A-CSP Grant Award

		Data Collection Form: Part A – Grant Award Information
Organization Name:
Contact Person:
Department of Contact Person:
PR/Award #:
Project Period Begin Date:
Project Period End Date:
Total Award Amount Obligated:
			The award amount includes the total amount obligated to your organization - both the original Grant Awards and any Supplemental Grant Awards - during the current project period. See the breakdown of funds across years below.
			Please list the number of schools for each Fiscal Year that are still receiving CSP funds within your project period. On the following worksheets, you will provide information for each of these schools.
			Number of new schools funded per Fiscal Year
FY 2013
FY 2014
FY 2015
FY 2016
FY 2017
		Total Number of Schools Funded:	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 data for each school
		OMB Number: 1855-0016 Approval Expires 5/31/2018

---

Sheet 3: Part B-CSP Schools Funded

Data Collection Form: Part B – School Award Information
		1) Charter School Contact Information. For each school funded, please identify: 1) the name and contact information for the charter school; and 2) the district/LEA information, including whether or not the school acts as its own LEA.																2) Charter School Authorizer. Please identify the charter authorizer by type and name.							3) School Award Information. Please provide the breakdown of funds awarded to schools from each Federal Fiscal Year. The total amount awarded across one or more years should equal the Total CSP Funding Amount for that school. In addition to providing the breakdown of funds awarded, please list the budget period for the time the funds were awarded.																													4) Charter School Operation. Please indicate the school status, the school year in which the charter school first enrolled students, planned grades, planned enrollment, grades served and enrollment prior to CSP funding, and prior CSP awards. While we can access some of this information in EDFacts, it is not always available for charter schools, so we must also request it here.								Additional Comments.
																											Total award amount obligated from ED (from Part A)-->	$0	$0	<--Total FY 2017 award amount from ED (from Part A)				$0	<--Total FY 2016 award amount from ED (from Part A)				$0	<--Total FY 2015 award amount from ED (from Part A)				$0	<--Total FY 2014 award amount from ED (from Part A)				$0	<--Total FY 2013 award amount from ED (from Part A)
																											Total school funding amount (sum of column AC)-->	$0	$0	<--Total FY 2017 dollars allocated (sum of column AD)				$0	<--Total FY 2016 dollars allocated (sum of column AI)				$0	<--Total FY 2015 dollars allocated (sum of column AN)				$0	<--Total FY 2014 dollars allocated (sum of column AS)				$0	<--Total FY 2013 dollars allocated (sum of column AX)
																											Total award amount remaining from ED (from Part A)-->	$0	$0	<--Total remaining				$0	<--Total remaining				$0	<--Total remaining				$0	<--Total remaining				$0	<--Total remaining
		Charter School Information							LEA Information									Authorized Public Chartering Agency											F Y 2 0 1 7 F U N D S (10/1/17-9/30/18)					F Y 2 0 1 6 F U N D S (10/1/16-9/30/17)					F Y 2 0 1 5 F U N D S (10/1/15-9/30/16)					F Y 2 0 1 4 F U N D S (10/1/14-9/30/15)					F Y 2 0 1 3 F U N D S (10/1/13-9/30/14)
		Charter school name	School NCES ID	address line 1	address line 2	city	state	zipcode	LEA name	LEA NCES ID	address line 1	address line 2	city	state	zipcode	Does the charter school act as its own LEA?	Is it an LEA with only charter schools?	Authorizer Type (choose one)	Authorizer Name	address line 1	address line 2	city	state	zipcode	Replication or Expansion	CSP Funding Period Begin Date	CSP Funding Period End Date	Total CSP Funding Amount	Dollar amount of CSP Funding	Beginning date of budget period	End date of budget period	Grades Served in 2017-18 (if not opened, enter "0")	School enrollment in 2017-18 (if not opened, enter "0")	Dollar amount of CSP Funding	Beginning date of budget period	End date of budget period	Grades Served in 2016-17 (if not opened, enter "0")	School enrollment in 2016-17 (if not opened, enter "0")	Dollar amount of CSP Funding	Beginning date of budget period	End date of budget period	Grades Served in 2015-16 (if not opened, enter "0")	School enrollment in 2015-16 (if not opened, enter "0")	Dollar amount of CSP Funding	Beginning date of budget period	End date of budget period	Grades Served in 2014-15 (if not opened, enter "0")	School enrollment in 2014-15 (if not opened, enter "0")	Dollar amount of CSP Funding	Beginning date of budget period	End date of budget period	Grades Served in 2013-14 (if not opened, enter "0")	School enrollment in 2013-14 (if not opened, enter "0")	School Status	School year in which the school first enrolled students or planned opening date	Grades served prior to expenditure of CSP funds (if not opened, enter "0")	School enrollment prior to expenditure of CSP funds (if not opened, enter "0")	Planned Grades	Planned Enrollment	Previous CSP Grant (Project Grade Levels)	Previous CSP Grant (Funding amount)	If you need to provide any additional information regarding this school, please use the box below. You may also direct comments to us at [email protected] or call toll-free 866-902-4887.
School	1																											$0.00
School	2																											$0.00
School	3																											$0.00
School	4																											$0.00
School	5																											$0.00
School	6																											$0.00
School	7																											$0.00
School	8																											$0.00
School	9																											$0.00
School	10																											$0.00
School	11																											$0.00
School	12																											$0.00
School	13																											$0.00
School	14																											$0.00
School	15																											$0.00
School	16																											$0.00
School	17																											$0.00
School	18																											$0.00
School	19																											$0.00
School	20																											$0.00
School	21																											$0.00
School	22																											$0.00
School	23																											$0.00
School	24																											$0.00
School	25																											$0.00
School	26																											$0.00
School	27																											$0.00
School	28																											$0.00
School	29																											$0.00
School	30																											$0.00
School	31																											$0.00
School	32																											$0.00
School	33																											$0.00
School	34																											$0.00
School	35																											$0.00
School	36																											$0.00
School	37																											$0.00
School	38																											$0.00
School	39																											$0.00
School	40																											$0.00
School	41																											$0.00
School	42																											$0.00
School	43																											$0.00
School	44																											$0.00
School	45																											$0.00
School	46																											$0.00
School	47																											$0.00
School	48																											$0.00
School	49																											$0.00
School	50																											$0.00
School	51																											$0.00
School	52																											$0.00
School	53																											$0.00
School	54																											$0.00
School	55																											$0.00
School	56																											$0.00
School	57																											$0.00
School	58																											$0.00
School	59																											$0.00
School	60																											$0.00
School	61																											$0.00
School	62																											$0.00
School	63																											$0.00
School	64																											$0.00
School	65																											$0.00
School	66																											$0.00
School	67																											$0.00
School	68																											$0.00
School	69																											$0.00
School	70																											$0.00
School	71																											$0.00
School	72																											$0.00
School	73																											$0.00
School	74																											$0.00
School	75																											$0.00
School	76																											$0.00
School	77																											$0.00
School	78																											$0.00
School	79																											$0.00
School	80																											$0.00
School	81																											$0.00
School	82																											$0.00
School	83																											$0.00
School	84																											$0.00
School	85																											$0.00
School	86																											$0.00
School	87																											$0.00
School	88																											$0.00
School	89																											$0.00
School	90																											$0.00
School	91																											$0.00
School	92																											$0.00
School	93																											$0.00
School	94																											$0.00
School	95																											$0.00
School	96																											$0.00
School	97																											$0.00
School	98
School	99
School	100
School	101
School	102
School	103
School	104
School	105
School	106
School	107
School	108
School	109
School	110
School	111
School	112
School	113
School	114
School	115
School	116
School	117
School	118
School	119
School	120
School	121
School	122
School	123
School	124
School	125
School	126
School	127
School	128
School	129
School	130
School	131
School	132
School	133
School	134
School	135
School	136
School	137
School	138
School	139
School	140
School	141
School	142
School	143
School	144
School	145
School	146
School	147
School	148
School	149
School	150
School	151
School	152
School	153
School	154
School	155
School	156
School	157
School	158
School	159
School	160
School	161
School	162
School	163
School	164
School	165
School	166
School	167
School	168
School	169
School	170
School	171
School	172
School	173
School	174
School	175
School	176
School	177
School	178
School	179
School	180
School	181
School	182
School	183
School	184
School	185
School	186
School	187
School	188
School	189
School	190
School	191
School	192
School	193
School	194
School	195
School	196
School	197
School	198
School	199
School	200
School	201
School	202
School	203
School	204
School	205
School	206
School	207
School	208
School	209
School	210
School	211
School	212
School	213
School	214
School	215
School	216
School	217
School	218
School	219
School	220
School	221
School	222
School	223
School	224
School	225
School	226
School	227
School	228
School	229
School	230
School	231
School	232
School	233
School	234
School	235
School	236
School	237
School	238
School	239
School	240
School	241
School	242
School	243
School	244
School	245
School	246
School	247
School	248
School	249
School	250
School	251
School	252
School	253
School	254
School	255
School	256
School	257
School	258
School	259
School	260
School	261
School	262
School	263
School	264
School	265
School	266
School	267
School	268
School	269
School	270
School	271
School	272
School	273
School	274
School	275
School	276
School	277
School	278
School	279
School	280
School	281
School	282
School	283
School	284
School	285
School	286
School	287
School	288
School	289
School	290
School	291
School	292
School	293
School	294
School	295
School	296
School	297
School	298
School	299
School	300

---

Sheet 4: Summary Sheet

		Data Collection Form: Summary Sheet
Check your data:	This sheet summarizes the CSP Grant Award Data already provided in Part A and the CSP School Award data you entered in Part B. If there are discrepancies in the amount of funds obligated and awarded in each Federal Fiscal Year, please use the gray space below to explain.
Organization Name:	0
Contact Person:	0
Department of Contact Person:	0
PR/Award #:	0
Project Period Begin Date:	1/1/1904
Project Period End Date:	1/1/1904
Total Award Amount Obligated:	$0
					|------------Summarized from Part B------------|
		Supplemental Award Amount	Number of school awards per Fiscal Year	Total award amount from ED per fiscal year	Total school award amount per fiscal year	Total remaining
FY 2013	$0	$0	0	$0	$0	$0
FY 2014	$0	$0	0	$0	$0	$0
FY 2015	$0	$0	0	$0	$0	$0
FY 2016	$0	$0	0	$0	$0	$0
FY 2017	$0	$0	0	$0	$0	$0
		Total Number of Current Active School Awards:	0	$0	$0	$0
		Comments or questions? Please contact us at [email protected], or call toll-free 866-902-4887.
		OMB Number: 1855-0016 Approval Expires 5/31/2018