Request for Proposal 

Eastern Promise Replication Grant

2014-2015

Grant Application Due Date: By Noon, March 10, 2014

Oregon Department of Education
Office of Learning
255 Capitol Street NE
Salem, OR  97310-0203

Table of Contents

I.	Background and Legislative Intent	1	1-2	
II.	General Information		3-7	
	A.	Purpose				3
	
	B.     Type of Grant……………………………………………………………………….	4	
	C.	Eligibility				4	
	D.	Grant Requirements			4-5	
	E.	Use of Funds		5	
	F.	Reporting and Assurances		6	
	G.     Scoring and Appeals Process		6-7	
III.     	Application Process………………………………………………………………….………	8-11	
	A.	Timeline and Important Dates		8	
	B.	Required Application Section	-	8
	
	C.     Format and Application Instructions for Submission		9    	
IV.	Application Narrative 		   10-11
	
V.     	Appendix …………………………..……………………………………………….………	12-17	
Appendix A:  Definitions	

Appendix B:  Required Documentation – List and Forms	…

Appendix C:  Budget Worksheet	…	12

13-16

17	

		
It is the policy of the State Board of Education and a priority of the Oregon Department of Education that there will be no discrimination or harassment on the grounds of race, color, sex, marital status, religion, national origin, sexual orientation, age or disability in any educational programs, activities, or employment.  Persons having questions about equal opportunity and nondiscrimination should contact the Oregon Department of Education, 255 Capitol Street NE, Salem, OR 97310; Telephone (503) 947-5600; Fax (503) 378-5156.

I. BACKGROUND and LEGISLATIVE INTENT

	In 2013, under the leadership of Governor John Kitzhaber, the Oregon Education Investment Board proposed key strategic investments to support Oregon’s attainment of 40/40/20.  Essential to this work is the creation of Consortiums to expand the Eastern Promise collaborative education model beyond one region within the state of Oregon.  The expansion is expected to increase the opportunity for students to participate in college-level courses and to cross-train faculty and staff in the development and assessment of curricular proficiencies. Conceptualized and passed by the legislature in HB 3232, the Consortia will receive funding to implement the core pillars of the Eastern Promise collaborative education model within two to three additional regions of Oregon.  The immediate purpose of this expansion is the attainment of 40/40/20 by increasing the number of students who are prepared to attend college directly from high school.

The Consortia will receive funding to implement a platform of services with the expressed purpose to:
1.	Promote the values of education and to advance the number of students prepared to attend college or other post-secondary programs directly out of high school.  
2.	Cultivate Professional Learning Communities among a blend of high school, college and university faculty who are charged with the development and assessment of curricular proficiencies in the Eastern Promise model.  

HB 3232 specifically directed the Department to distribute monies to consortiums to design and deliver individualized, innovative and flexible ways of delivering content, awarding high school and college credit and providing developmental education for students in high school or in the first two years of post-secondary education.  

The rules established an Eastern Promise Replication Grant to support expansion. The grant is available to school districts, education service districts, community colleges, and public or private  post-secondary institutions.  The purposes of the grant are to increase student success and establish Professional Learning Communities. 

The Eastern Promise collaborative model has successfully broken down barriers of student achievement by consolidating resources and improving efficiences.  The expansion of this program has the potential to significantly decrease the achievement gap across the state and move us closer to the 40/40/20 goal understanding that the success of every child in Oregon is directly tied to the prosperity of all Oregonians.  An Eastern Promise expansion can increase the dialogue to align high school curriculum with post-secondary expectations while preparing students for their post-secondary aspirations.  By preparing students earlier in their academic experience, we increase the likelihood a larger number of students will enter tenth grade having earned six or more credits toward graduation and prepared to access accelerated high school courses. 

Eastern Promise has a commitment and promise established between Eastern Oregon University, Blue Mountain Community College, Treasure Valley Community College and the InterMountain Education Service District to partner with PK-12 Schools.  Their success includes significantly increasing the number of high school students earning 9+ college credits.

All Eastern Promise Replication Grant sites will be expected to incorporate and adopt the principles of OEIB Equity Lens; through this perspective the Oregon Department of Education considers the creation of strategic opportunities for educational equity and excellence for every child and learner in Oregon.  The Equity Lens provides twelve core beliefs that fuel opportunities to bolster success for diverse student populations across the state. The beliefs most pertinent to the work of this grant are highlighted below:

•	We believe that everyone has the ability to learn and that we have an ethical responsibility and moral responsibility to ensure and education system that provides optimal learning environments that lead students to be prepared for their individual futures.. 

•	We believe that our community colleges and university systems have a critical role in serving our diverse populations, rural communities, English language learners and students with disabilities. Our institutions of higher education, and the P-20 system, will truly offer the best educational experience when their campus faculty, staff and students reflect this state, its growing diversity and the ability for all of these populations to be educationally successful and ultimately employed.

•	We believe that the students who have previously been described as “at risk,” “underperforming,” “under-represented,” or minority actually represent Oregon’s best opportunity to improve overall educational outcomes.  We have many counties in rural and urban communities that already have populations of color that make up the majority. Our ability to meet the needs of this increasingly diverse population is a critical strategy for us to successfully reach our 40/40/20 goals.

•	We believe that resource allocation demonstrates our priorities and our values and that we demonstrate our priorities and our commitment to rural communities, communities of color, English language learners, and out of school youth in the ways we allocate resources and make educational investments.

•	We believe that communities, parents, teachers, and community-based organizations have unique and important solutions to improving outcomes for our students and educational systems.  Our work will only be successful if we are able to truly partner with the community, engage with respect, authentically listen—and have the courage to share decision making, control, and resources.

II. GENERAL INFORMATION

A.	Purpose of the Eastern Promise Replication Grant
The Eastern Promise Replication Grant of 2014-2015 is intended to support consortiums of school districts and post-secondary institutions in building a collaborative effort to develop innovative and flexible ways to create additional opportunities for high school students to participate in college-level courses and earn college credits and/or certificates while still in high school, as well as building a college-going culture and attitudes through programs that begin serving students and families as early as 5th grade. Consortiums will serve a combined total of at least 10,000 students and must include:

(a)	At least one public or private Oregon university;
(b)	At least one Oregon community college; 
(c)	At least three school districts;
(d)	At least one education service district.

The successful replication model proposed will clearly articulate how it will incorporate the following key elements of Eastern Promise: 
(a)	A commitment to a cross-sector collaboration between a university, community college(s), education service district(s) and districts where each partner is engaged as an equal partner.
(b)	A commitment to providing students with a variety of accelerated learning opportunities such as online courses, proficiency-based opportunities, CTE, Dual Credit, Advanced Placement, International Baccalaureate, and to ensure students receive support and specific instruction around knowledge, skills and behaviors necessary to be successful in college-level coursework or post-secondary training.
(c)	A commitment to building a college-going culture, which refers to the environment, attitudes, and practices in schools and communities that encourage students and their families to obtain the information, tools and perspective to enhance access to and success in post-secondary education. 
(d)	A commitment to developing cross-sector professional learning including faculty and teachers from university, community college, ESD and high school to ensure that all levels of instruction are represented and participate in establishing appropriate curriculum and shared assessment to measure outcomes.

The Consortiums selected for the Eastern Promise Replication Grant will collaborate with the Eastern Oregon Eastern Promise program throughout the process of implementation to receive support and technical assistance.  

We prioritize efforts that align with the Oregon Education Investment Board adoption of the Equity Lens, the State’s 40/40/20 goal, and efforts that strive to close the Achievement Gap.

B.	Type of Grant
	Based on the availability of state resources, this grant begins April 9, 2014 and ends on June 30, 2015.  The Oregon Department of Education, in collaboration with the office of the Chief Education Officer, will review progress reports and performance data to determine future and continued program funding.

The Department may award two to three grants in regions beyond eastern Oregon totaling between $465,000 -$650,000. 

C.	Eligibility 
The Eastern Promise Replication Grant is a competitive grant.  
The Department shall determine the amount of each grant based on the funds available and each grant application. The Department shall allocate funds for the grant program based on an evaluation of the grant application and to what extent the applicant has met the grant requirements along with the following considerations:

(a)	Geographic location of district to ensure geographic diversity among the recipients of grant program funds throughout the state;
(b)	Districts that have Achievement Gaps between subgroup populations; 
(c)	Districts that have a high level of students who are economically disadvantaged.

D.	Grant Requirements
	Grantees will:

(1)	Detail how the funds will be used to reach the 40-40-20 goal by expanding the core pillars of the Eastern Promise early college experiences and Professional Learning Communities (PLC) to reach a combined total of at least 10,000 students. 

(2)	Utilize the Equity Lens when developing a plan for implementing the core pillars of the Eastern Promise education model and PLC’s at demonstration sites;

(3)	Demonstrate support, commitment and readiness to design or revise programming specifically for offering early college experiences and developing Professional Learning Communities; 

(4)	Reflect a commitment to cross-sector collaboration between a university, community college(s), education service district(s) and districts where each partner is engaged as an equal partner;
(5)	Detail their commitment to providing students with a variety of accelerated learning opportunities, such as on-campus experiences, on-line courses, proficiency-based opportunities, dual credit, Advanced Placement, International Baccalaureate, and to ensuring students receive support and specific instruction around the knowledge, skills and behaviors necessary to be successful in college-level coursework; 
 		
(6)	Demonstrate a commitment to developing cross-sector professional learning; including faculty and teachers from the four year institution, and community college and ESD/high schools of like disciplines.  The consortium will ensure that all levels of instruction are represented and participate in discussing and establishing the appropriate curriculum, and in developing appropriate and shared assessment parameters to measure outcomes;

(7)	Offer a plan to build a college-going culture beginning in middle grades or even earlier, which refers to the environment, attitudes, and practices in schools and communities that encourage students and their families to obtain the information, tools, and perspective to enhance access to and success in post-secondary education.  The applicant should describe a plan for one or more programs servicing students, beginning in middle grades that:

a.	Helps students’ learn about options for their future, careers and the education they require;
b.	Convey the expectation that all students can prepare for the opportunity to attend and be successful in post-secondary education; and
c.	Ensure schools, families, and communities give students the same message of high expectations for their future.  

E.	Use of Funds
	Grantees must be able to spend funds according to acceptable accounting procedures and be able to provide evidence of such procedures.  All funds will be provided through the Electronic Grants Management System (EGMS). Costs must be necessary and reasonable to complete the project and be authorized and not prohibited under State or local laws.
	
Reasonable costs will not exceed that which would be incurred by a prudent person, are ordinary and necessary for the operation of the program, and represent sound business practices.  Lack of documentation is a primary reason for audit findings.  Documentation must be available to support each expenditure and may be requested by the Oregon Department of Education at any time.
	
Funds will be available upon official notification (anticipated notification on or about April 9, 2014) through June 30, 2015.  Grant funds may not be used outside of the award period.

Use of funds may include (but are not limited to) the following:
•	Stipend and travel reimbursements for individuals attending meetings, conferences, or other professional development activities with a strong alignment to the project outcomes and activities.
•	Release time for educators during the school year for planning activities related to the project.
•	Materials and equipment for classroom implementation related to the content of project activities.
•	Direct staff expenses related to program, activities, coordination and evaluation to project activities.  Salary and benefits not to extend beyond June 30, 2015.
•	Consultation services with a direct alignment to the project outcomes and activities.
•	Support of professional development programs aligned to the project outcomes and activities.
•	Reasonable expenditures for food at professional development sessions.
•	Indirect administrative costs not to exceed 3-5% of the total proposed budget.
•	Materials used primarily for general classroom use and professional development trainings.

Funds may not be used for:
•	Costs associated with writing the proposal.
•	Contractual obligations that extend beyond June 30, 2015, or began prior to the award date.
•	Purchase of equipment that becomes the property of any individual or organization other than eligible project partners or recipients.
•	Purchase of services for personal benefit beyond the project outcomes and activities.
•	Support for travel to out-of-state professional meetings/conferences unless the meeting is identified in the proposal and attendance will directly and significantly advance the project.  Approval, post-award, may be granted by ODE on a case-by-case basis.
•	Purchase of office equipment unless directly linked to the program outcomes.

	F.	Reporting and Assurances
	Successful proposals will include specific project outcomes, and an evaluation plan that will provide evidence there has been progress toward meeting those outcomes within the timeline of the grant.  Progress must be documented and measureable, observable through anecdotal records, or documented through other records.  The results of the evaluation will be reported to ODE as part of an interim and final Grant Report.  The evaluations will be included in the report to the Oregon Legislature.  Any submission of evaluation materials that include images of minors must be accompanied by a signed release form by a parent or guardian.

		To facilitate program analysis, recipients will provide additional data related to the 	impact of the project on students, teachers and community partners.  This data may 		include but are not limited to the following:
•	Two progress reports. 
•	Interviews and/or surveys conducted by ODE staff or evaluators.
•	Data on specific measures of student and teacher knowledge and skills related to project outcomes.

	By signing the assurances included in this application, school districts, non-profit organizations, postsecondary institutions, and community partners agree to cooperate with ODE and OEIB to collect and report such data to the extent that it is possible.

G.  Scoring and Appeals Process
	A review committee will score all complete grant applications that were electronically submitted to Joy Blackwell (joy.blackwell@state.or.us) at the Oregon Department of Education by 12:00 p.m. on Monday, March 10th.  All applications will be scored using
the scoring criteria equivalent to the criteria provided in this document.  Each application will have at least three reviewers.  When possible, each proposal will be scored by at least two reviewers from the following sectors: community member, post-secondary education faculty, student-focused nonprofit, Oregon Department of Education equity team, K-12 education representative, professional development or afterschool provider. No direct applicant will be accepted as a reviewer.  

After scores are compiled, the applications will be placed in rank order.  The Eastern Promise Replication Grant Review Committee will make final recommendations based on the score, funding requirements established in the Oregon Legislative Budget Notes for Eastern Promise replication initiatives, adequate geographic distribution beyond eastern Oregon, and overall number of students and educators impacted.  The Deputy Superintendent of Public Instruction will make the final award decision.

The Oregon Department of Education will notify both successful and unsuccessful applicants and will provide a summary of comments and suggestions related to their applications. Applicants will have one week from the date of the notification letter to contest the funding decision through the process identified in the notification. Once appeals have been considered, the award decisions made by the Deputy Superintendent are final.  

III. Application Process

A.	Timeline and Important Dates

Completion Dates	Activities	
January 27, 2014	Release of Request for Proposal (RFP)	
February 12, 2014 and March 3, 2014	Webinar on Application Process and Submission	
March 10, 2014	Applications due to ODE by 12:00PM PDT 	
March 11-31, 2014	Applications reviewed and scored 	
April 9, 2014	Applicants expected to be notified of award 	
May 15, 2015	Last date to expend funds on grant activities	
June 30, 2015	Last date to draw funds	
July 31, 2015	Final grant report due	

B.	Required Application Section
(1)	Application Cover Page – Complete and include the form provided in Appendix B.

(2)	Statement of Commitment from Each Lead Organization – School District or Non-Profit Organization working with at least one School District, School Board Chair(s) and Consortia Leadership complete and sign the Statement of Commitment provided in Appendix B and include in the application.

(3)	List of Additional Partners – Complete and include this form provided in the appendix.

(4)	Application Narrative – Please refer to the specific format section listed as Application Narrative in the following section.  This section will be at least 10 pages but should not exceed 15 pages. 

(5)	Budget Worksheet and Budget Narrative – The budget worksheet should clearly reflect activities in the grant and represent reasonable costs associated with the activities.  Budget worksheets are provided in Appendix C.  The budget narrative should provide clarity to the budget worksheet by describing how the amounts were determined.  Major single expenditures should be itemized and linked to specific grant activities.

(6)	Appendix – Not required, however, any supporting charts, graphs, and tables may be placed in the appendix and referenced in the Grant Narrative.

C.	Format and Application Instructions for Submission
•	12-point font, Times New Roman
•	Double spaced
•	1-inch margins on the sides, top, and bottom of 8½” by 11” paper
•	15-20 page narrative maximum, (excluding cover page, assurances, bibliography, and budget template)
•	No faxed applications 
•	Numbered pages
•	Name the file in this format: The agency it is being submitted from, underscore, and Eastern Promise Replication Grant (ex. Oregon Department of Education_Eastern Promise Replication Grant)

An electronic version of the completed application including a scanned copy of the signed Statement of Assurances and Statement of Commitment, in Word (.doc or .docx), or PDF format must be received by 12:00 pm on March 10, 2014.  Please use the Secure File Transfer Process outlined below to submit the electronic version of the grant application. 

Secure File Transfer Process – An electronic version of the complete application must be submitted to Joy Blackwell joy.blackwell@ode.state.or.us using the Secure File Transfer system available on the ODE district website: https://district.ode.state.or.us/apps/xfers/.  Follow the instructions provided on the secure file transfer website. Multiple files must be compressed (zipped) into a single folder for submission.  Please name the files as follows: the agency it is being submitted from, underscore, and Eastern Promise Replication Grant (ex. Oregon Department of Education Eastern Promise Replication Grant).  Only complete applications submitted by the due date will be scored.  Contact the ODE helpdesk at 503-947-5715 if you need assistance with the Secure File Transfer Process.

Please send a hard copy of the original signed Statement of Assurances which should be postmarked by Monday, March 10, 2014 to:

Oregon Department of Education
Office of Learning
255 Capitol Street NE
Salem, Oregon 97310-0203
Attention: Deborah Banks

Envelopes must be plainly marked: Request for Application—Eastern Promise Replication Grant

An electronic version of the Grant Application must be received by:

12:00 PM on March 10, 2014

An electronic version of the Grant Application
must be received by
12:00 PM on March 10, 2014

IV. Application Narrative and Scoring Guidance

The Eastern Promise is a collaborative effort between an education service district(s), community college(s), and a state university along with thirty-three school districts in the Eastern Oregon region.  The program creates additional opportunities for high school students to participate in college-level courses and earn college credits and/or certificates while still in high school, as well as builds a college-going culture and attitudes through programs that begin serving students and families as early as 5th grade.  It is expected the expansion programs will include the core pillars of the Eastern Promise program success and serve a combined total of at least 10,000 students. 

(A)	Vision, History and Context (20%)

1.	What is the long-term vision for expanding the Eastern Promise collaborative education model and what steps will be taken towards realizing this vision?
2.	What changes to student learning and teacher effectiveness are expected as a result of the implementation of the Eastern Promise collaborative education model?
3.	What evidence-based promising approaches do you anticipate using in order to achieve the goals and needs of the Eastern Promise collaborative education model? (e.g., educator professional development, student proficiency portfolios, collection and analysis of student performance data, etc.)
4.	What are the special attributes and resources in the Consortia that will enable this project to be effective?
5.	How will your plan implement the principles of the Equity Lens in order to reduce the Achievement Gap in your region?

(B) Community Demographics and Needs Analysis (20%)
1.	Please identify the barriers you imagine encountering and the strategies for overcoming them.  Please include support the state can provide in helping overcome those barriers.
2.	Also provide relevant student and economic data that relates to addressing issues of the historically underserved and underrepresented population, specifically:
a.	African American, American Indian/Alaskan Native, girls, Hispanic/Latino and Native Hawaiian/Pacific Islander populations.  
b.	Students with disabilities and economically disadvantaged populations.

(C)	Goals, Evaluation and Sustainability Plan (25%)
1.	What are the specific agreed upon goals for increasing the number of underserved students earning 9 or more college credits while in high schools, increasing the regions high school completion rate and increasing the number of students, particularly underserved students, enrolling in college? 
2.	What are the evaluation questions that you will answer in order to support your theory of change?
3.	Describe the data collection and methodologies that you will use to determine the extent to which your education intervention impacts your intended outcomes.
4.	Provide a description of the measures you will use to assess your impact on student, educator, and/or community outcomes, including how they were developed and evidence of their reliability and validity.
5.	What is the plan to sustain the programs and infrastructure beyond the funding period?  

(D)	Partnerships and Community Assets (25%)
1.	What is the involvement of the consortia members within the partnership?
2.	What steps will be taken to reach out to parents and community organizations to ensure that those groups understand the importance of building a college going culture and what it means to support students in accessing post-secondary opportunities?
3.	What is your plan for regularly communicating and engaging with external and internal stakeholders?  
4.	How do you see your regional partnerships growing and adapting over time? Also include the potential challenges in the long-term viability of replication the Eastern Promise model in your region.
5.	Please provide a sample, in the appendix, of your partnership agreements and a compiled list of the organizations directly involved in the implementation plan.

(E) Budget Worksheet and Budget Narrative (10%)
1.	Please develop a budget based on anticipated activities through the end of the biennium. Describe how state funds will be leveraged by private funding or in-kind donations of time and materials. Please list additional support that has been committed for the development and implementation to support Eastern Promise replication. 
2.	Describe how the amount in each line item of the budget was determined.  These should clearly reflect the descriptions to the proposed activities.  Major single expenditures exceeding $1,000 should be itemized and linked to the specific grant activities.  Also, include the following:
•	Identify roles and responsibilities for each individual with a salary funded partially or entirely though this grant.
•	Identify the nature of any contracted services included in the professional and technical services.

Appendix A
Definitions

(1)  “Consortium” means the equal partnership developed to form the cross-sector collaboration between eligible educational institutions. 

(2) “Proximity” means the four-year institution participating in the program will have a branch campus located within 150 miles of their community college partners’ regional borders.

(3)  “Postsecondary Institution” means:
(a)	 A community college operated under ORS chapter 341
(b)	The following public universities within the Oregon University System:
(A)	University of Oregon
(B)	Oregon State University
(C)	Portland State University
(D)	Oregon Institute of Technology
(E)	Western Oregon University
(F)	Southern Oregon University
(G)	Eastern Oregon University
(c)	Oregon Health and Science University
(d)	An Oregon-based, generally accredited, not-for-profit institution of higher education

(4) “Significant population” means to serve the majority of underserved students within the consortium’s region.  

(5) “Underserved student” means a student (English language learner, student of color, an economically disadvantaged student or a student with disabilities) who has not historically taken high school accelerated courses and may not have considered enrolling in a post-secondary education program. 

(6) “Variety” means students having access to a choice of courses offered in core academic subjects, in different forums (which include yet are not limited to distance learning, high school campus, college campus, by proficiency assessment or through credit for prior learning), that are eligible for transfer.  

(7) “Achievement Gap” means the gap in achievement (state test scores in reading, writing, and mathematics as well as diploma and post-secondary degree attainment) that often exists between students who are economically disadvantaged, students with disabilities, students learning English as a second language, African American, Hispanic or Native American when compared to their peers. 

(8) “Equity Lens” refers to the commitment and principles adopted by the Oregon Education Investment Board to address inequities of access, opportunity, interest, and attainment for underserved and underrepresented populations in all current and future strategic investments.

Appendix B

APPLICATION COVER PAGE 
(Please Print or Type – All Fields Must Be Completed)

REQUESTED FUNDING		
TOTAL # OF STUDENTS THAT WILL BE SERVED:		
TOTAL # OF PARTNERS IN CONSORTIUM:		
Name of Consortium:		
Name of one or more public or private Oregon University:		
		
Name of one or more Community College(s):		
		
Name of one or more Education Service District(s):		
		
Name of three or more School District(s):		

Non-Profit Organization(s):		
		
County for each Consortium Partner:		

Project Director: 		
Mailing Address:		
City:		State:		Zip:		
Phone:		FAX:		E-mail		
Grant Fiscal Agent Name and Title:		
Phone:		FAX:		E-Mail		

2014-2015 Statement of Assurances

•	The fiscal agent assures and certifies compliance with the regulations, policies, and requirements as they relate to the acceptance and use of state funds for programs included in this application.
•	The recipient or the senior designate agrees to carry out the partnerships and use of funding as proposed in the application.
•	The Eastern Promise Replication Site project director will submit an interim evaluation report on or before October 27, 2014 and an end of grant report on or before July 31, 2015 to the Oregon Department of Education as outlined in the RFP.  
•	Violations of the rules or laws may result in sanctions, which may include but are not limited to reduction or revocation of grant award.
•	The fiscal agent is responsible for adopting and adhering to the Equity Lens and their principles throughout their Eastern Promise Replication Sites.
•	The applicant certifies that to the best of his/her knowledge the information in this application is correct; that the filing of this application is duly authorized by the governing body of this organization, or institution, and that the applicant will comply with the general statement of assurances.
•	The applicant certifies to the best of his/her knowledge the guidelines for Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) are being followed.  It is a Federal law that protects the privacy of student education records.

					
Please Print Name of Project Director		Signature of Project Director		Date	

Statement of Commitment from Partners
 (Please Print or Type)
Consortium Site Name:		
Name of one or more public or private Oregon University:		
Name of one or more Community College(s):		
Name of one or more Education Service District(s):		
Name of three or more School Districts:		
		
Nonprofit Organization:		
Name:		Title:		
Mailing Address:		
City:		State:		Zip:		
Phone:		FAX:		E-mail:		

Please explain the role of this partner in the proposed Eastern Promise Replication Plan, contributions that this partner will make, and evidence that the proposed activities are integral to this partnership’s plan:
Describe what supports this stakeholder will provide to enhance the collaborative education model.  Please provide a statement of commitment and contribution to the Eastern Promise project resources (financial, in-kind, materials, expertise, etc.), that may continue beyond the life of the grant.  

Print Name of Authorized Agent		Signature of Authorized Agent		Date	

List of Additional Partners
Eastern Promise Replication Consortium*

The following individuals and/or organizations have reviewed, discussed, and agreed to their part in implementing proficiency-based teaching and learning as proposed in this grant application:

	Name	Title	Organization	Role/Responsibilities	
1.					
2.					
3.					
4.					
5.					
6.					
7.					
8.					
9.					
10.					

*In addition, a signed commitment form is required from each of the following stakeholders:
•	School District(s)
•	Public or Private Postsecondary Institution(s)
•	Nonprofit Organization(s)
•	Community College(s)

•	
Appendix C

Sample Eastern Promise Replication Budget Worksheet
Please modify as needed.
Project Name:	_______________________________________________________________
Fiscal Agent: ________________________________________________________________
Possible Grant Charges

Object Codes if necessary	In-School Programing (Expenditures NOT related to Staff Development)	Out-of-School Programing (Expenditures NOT related to Staff Development)	Instructional
Staff Develop
 (Instructional Staff Development)	Line Total	Anticipated Matching Funds	
	Staff Salaries	 		 			
	Staff Benefits	 		 			
	Instructional and Professional Services	 		 			
	In-State Travel	 		 			
	Curriculum development and access cost						
	Student and Parent information forums						
	Other general Professional & Technical Services	 		 			
	Supplies & Materials	 		 			
	Non-Consumable Items	 		 			
	Computer Software	 		 			
	Computer Hardware	 		 			
	Capital Outlay (Depreciable Technology)	 		 			
	Administrative Costs @
3- 5 % 	 		 			
Total by Function