ࡱ>  Gbjbj *b?Y!!!!!T5"5"5""l9#5"5p$%(%%%'''4444444q8;F4!'''''4!!%%4Y*Y*Y*'j!%!%4Y*'4Y*Y*1|2% ~/5"A(*<24405N2~Y;k)Y;$22Y;!2''Y*'''''44Y*'''5''''Y;''''''''' :  New Jersey School Improvement Grant COHORT 3 14-SG07-H03 7/1/2014 8/31/2017 LEA Application Application Due Date: April 1, 2014 New Jersey Department of Education P.O. Box 500 Trenton, NJ 08625-0500 HYPERLINK "http://www.state.nj.us/education"http://www.state.nj.us/education Form L-1 NEW JERSEY DEPARTMENT OF EDUCATION NOTICE OF GRANT OPPORTUNITY - TITLE PAGE- LEA SECTION I: 14 SG07 H03 FY NGO# WKL TITLE OF NGO: School Improvement Grant Program (SIG/Cohort 3) (Year 1 of 3) DIVISION: Academics OFFICE: School Improvement SECTION II: COUNTY:  FORMCHECKBOX  FORMCHECKBOX  LEA/OTHER:  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  SCHOOL:  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  COUNTY NAME:_____________________________ APPLICANT AGENCY AGENCY ADDRESS CITY STATE ZIP ( ) ( ) AGENCY TELEPHONE NUMBER AGENCY FAX PROJECT DIRECTOR (Please print or type name): _________________________________________________________________ TELEPHONE NUMBER: (____)___________________ FAX#: (____)__________________ E-MAIL_______________________________ BUSINESS MANAGER: _______________________________ PHONE#: (____)___________ E-MAIL_____________________________ DURATION OF PROJECT: FROM: 7/1/2014 TO: 8/31/2015 Note: pre-implementation period is from 5/1/14 to 6/30/14 TOTAL 3-YEAR AMOUNT OF FUNDS REQUESTED: $__________________________________________ APPLICATION CERTIFICATION: To the best of my knowledge and belief, the information contained in the application is true and correct. The document has been duly authorized by the governing body of this agency and we will comply with the attached assurances if funding is awarded. I further certify the following is enclosed: AGENCY TITLE PAGE SIGNED STATEMENT OF ASSURANCES BOARD RESOLUTION TO APPLY APPLICATION NARRATIVE* BUDGET SUMMARY AND BUDGET DETAIL FORMS* ORIGINAL AND FIVE COPIES OF THE COMPLETE APPLICATION PACKAGE ___________________________________________________ _________________________________________ ________________ SIGNATURE OF CHIEF SCHOOL ADMINISTRATOR TITLE DATE ___________________________________________________ (Please print or type name) *FAILURE TO INCLUDE A REQUIRED APPLICATION COMPONENT CONSTITUTES A VIOLATION OF THE NGO AND WILL RESULT IN THE APPLICATION BEING ELIMINATED FROM CONSIDERATION (See NGO Section 3.7 for itemized list). SECTION III: SEND OR DELIVER APPLICATIONS TO: APPLICATIONS MUST BE RECEIVED BY: NEW JERSEY DEPARTMENT OF EDUCATION APPLICATION CONTROL CENTER 4:00 P.M., ON 04/01/2014 RIVER VIEW EXECUTIVE PLAZA BLDG. 100, ROUTE 29 PO Box 500 TRENTON, NJ 08625-0500 Form L-2 BOARD RESOLUTION TO APPLY 14SG07H03 FY NGO# WKL The _________________________________ Board hereby certifies that permission has been granted to apply for the discretionary grant program entitled: School Improvement Grant for the purposes described in the application, in the amount of, $___________.00, starting on _____May 1, 2014__________, and ending on ___August 31, 2015____________. The filing of this application was authorized at the Board meeting held on, _____________________________, 20__ ______________________________ Secretary of the Board __________________________20__ Date Form L-3 STATEMENT OF ASSURANCES As the duly authorized chief school administrator/chief executive officer of the applicant agency, I am aware that submission to the Department of Education of the accompanying application constitutes the creation of a public document, and I certify that the applicant: Has the legal authority to apply for the funds made available under the requirements of the NGO, and has the institutional, managerial and financial capacity (including funds sufficient to pay the non-federal/state share of project costs) to ensure proper planning, management and completion of the project described in this application. Will give the New Jersey Department of Education, or its authorized representatives, access to, and the right to examine, all records, books, papers, or documents related to the award and will establish a proper accounting system in accordance with generally accepted accounting principles (GAAP). Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes, or presents the appearance of, personal or organizational conflict of interest, or personal gain. Will implement the program in accordance with the applicable Notice of Grant Opportunity and the approved grant application, to include timely submission of all associated reports, fiscal and otherwise. Will comply with provisions of the Public School Contracts Law: N.J.S.A. 18A:18A, and other relevant state laws and regulations. Is in compliance, for all grant awards in excess of $100,000.00, with the Byrd Anti-Lobbying amendment, incorporated at Title 31 U.S.C. 1352. This certification extends to all lower tier grantees as well. As well as its principals and subgrantees, for all grant awards in excess of $25,000.00, is not presently debarred, proposed for debarment, declared ineligible, suspended, or voluntarily excluded by any federal agency from receiving federal funds in accordance with Executive Orders 12549 and 12689. Will comply with Section 6002 of the Resource Conservation and Recovery Act (RCRA), P.L. 94-580, codified at 42 U.S.C. 6962 if the applicant is an entity of state and/or local government and will give preference to the purchase of recycled materials identified in U.S. EPA guidelines (40 CFR Part 247-254). Will comply with all federal and state statutes and regulations relating to nondiscrimination. These include, but are not limited to: (A) Title VI of the Civil Rights Act of 1964 (P.L 88-352; 34 CFR Part 100) which prohibits discrimination on the basis of race, color or national origin; (B) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1681-1683, and 1685-1686; 34 CFR Part 106), which prohibits discrimination on the basis of sex; (C) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794; 34 CFR Part 104), which prohibits discrimination on the basis of handicaps; (D) Section 503 of the Rehabilitation Act of 1973, as amended (41 CFR Parts 61-741.5(a)), as applicable, which requires affirmative action in employment; (E) the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101 et seq.; 45 CFR Part 90), which prohibits discrimination on the basis of age, and (F) the Americans With Disabilities Act of 1990, as amended (P.L. 101-336), which guarantees equal opportunity for individuals with disabilities. Will comply with Executive Order 11246, Equal Employment Opportunity, dated September 24, 1965, as amended by Executive Order 11375, dated October 13, 1967, and as supplemented by the regulations at 41 CFR Part 60. Will comply with the provisions of the Drug-Free Workplace Act of 1988, as implemented at 34 CFR Part 85, Subpart F, for grantees, as defined at 34 CFR Part 85, Sections 85.605 and 85.610. Will comply with the provisions of the Drug Free Schools and Communities Act Amendments of 1989, as implemented at 34 CFR Part 86, Subparts A-E (institutions of higher education only). Will comply with the provisions of the Federal Fiscal Accountability and Transparency Act (FFATA) and has provided in the application a correct and valid DUNS number for the applicant organization, as well as any controlling parent organization. Has a current and complete registration in the System for Award Management (SAM), located at www.sam.gov, prior to the submission of this application, and shall maintain a current SAM registration throughout the period of the award. Use its School Improvement Grant to implement fully and effectively an intervention in each Priority school, that the LEA commits to serve consistent with the final requirements; Establish annual goals, approved by the SEA, for student achievement on the States assessments in both reading/language arts and mathematics and measure progress on the leading indicators in order to monitor each Priority school that it serves with school improvement funds If implementing a restart model in a Priority school, include in its contract or agreement terms and provisions to hold the charter operator, charter management organization, or education management organization accountable for complying with the final requirements; Monitor and evaluate the actions a school has taken, as outlined in the approved SIG application, to recruit, select and provide oversight to external providers to ensure their quality; Monitor and evaluate the actions schools have taken, as outlined in the approved SIG application, to sustain the reforms after the funding period ends and that it will provide technical assistance to schools on how they can sustain progress in the absence of SIG funding Report to the SEA the school-level data required under section III of the final requirements; and Ensure that each Priority school that the LEA commits to serve receives all of the State and local funds it would have received in absence of the school improvement funds and that the resources will be aligned with the interventions. ______________________________________ Chief School Administrator Name ______________________________________ Chief School Administrator Signature ______________________________ 20___ Date Form L-4 Documentation of Federal Compliance (DUNS/SAM) Form Note: this form must be completed and returned by the applicant prior to any award being made. Part I Applicant Organization Organizational Name of Applicant __________________________________ Address including zip + 4 code __________________________________ DUNS number __________________________________ Expiration Date of SAM registration __________________________________ Congressional District __________________________________ Part II Primary Place of Performance under this award City __________________________________ County __________________________________ I certify that this information is complete and correct. Furthermore, the applicant certifies that it has completed its registration on the System for Award Management (SAM) website, found at HYPERLINK "http://www.sam.gov"www.sam.gov. and shall maintain a current registration throughout the grant period. _____________________________________________ Signature of Chief School Administrator _____________________________________________ Name and Title Form L-5 Date: ________________ Page ____ of ____ PROJECT ABSTRACT LEA : _____________________________________________________________ MissionVision  Project Implementation Summary  Form L-6 Date: _______________________ Page ____of ____ SCHOOLS TO BE SERVED LEA : _______________________________ SCHOOLS TO BE SERVED: An LEA must include the following information with respect to the schools it will serve with a School Improvement Grant. An LEA must identify each Priority Schools the LEA commits to serve and identify the model that the LEA will use in each Priority School. Provide the county, LEA and School code along with the NCES ID number. Add additional rows as needed.  PRIORITY SCHOOL NAMECO CODELEA CODESCH CODENCES ID #INTERVENTION TurnaroundRestartClosureTransformation Form L-7(a) Date: _______________________ Page ____of ____ STAKEHOLDER PARTICIPATION List the dates of the meetings when the Stakeholder Committee discussed the needs assessment and School Improvement Grant application development. Include all stakeholders currently required under state and federal statutory and regulatory requirements. Add rows as needed. Stakeholder MeetingsDateLocationTopicNumber AttendingAgenda on FileMinutes on FileNeeds AssessmentYesNoYesNoPlan Development List other methods and events to inform the school community about the SIG application. (For example: public meetings, posting on website, meetings with parents and community, and other communications) Stakeholder Informational Methods & Events Describe how stakeholders are involved in model implementation on an on-going basis. Identify the district team by name (The Chief School Administrator or designee, special education director, Title I director, supervisor of curriculum, SIG principal) who will meet monthly with the SEA/STC to discuss the following: Student achievement Walkthrough trends Attendance of students and staff Discipline data SIG component implementation Form L-7(b) Date: _______________________ Page ____of ____ STAKEHOLDER PARTICIPATION * Include all stakeholders currently required under state and federal statutory and regulatory requirements. Stakeholder Committee Form Name Stakeholder GroupParticipated in Needs AssessmentParticipated in SIG Application Development Signature* (*) The signature does not assume full approval of the needs assessment and application development. Rather, the signature denotes participation. Copy form as needed. Form L-8 Date: ________________ Page ____ of ____ LEA COMMITMENT AND CAPACITY LEA : _____________________________________________________________ See details for each item in the NGO. Describe the following: AThe LEAs SIG design and implementation interventionsBThe LEAs process to analyze the needs of each school and determine the selected interventionCThe LEAs recent history in improving schools DThe LEAs process to recruit, screen and select external providers to ensure their quality.EThe LEAs plan for alignment of other resources and supportsFThe LEAs plan to modify its practices or policies, if necessary, to enable it to implement the interventions fully and effectivelyGThe LEAs plan to sustain the reforms after the funding period endsHThe LEAs plan to provide for greater school-level autonomy and more flexibility for the leadership (principal) of the school including but not limited to selection of staff, budgeting, scheduling, selection of professional development providers, and greater accountability for resultsIThe LEAs qualifications for the new principal, principal competencies, search and selection of a new principal with experience turning around chronically low performing schools. The new principal must be selected by July 1, 2012. Indicate the number of years in the school of the current principal.JThe LEAs commitment and capacity to manage the program, organize the work, and meet deadlines; a clear process for making collaborative decisions, a management plan outlining the ability to manage the program in the served schools; an outline of the process for meeting identified needs and deadlines the specific and definitive roles for leaders and stakeholders in the program; LEA activities to support the schools; and a projected plan. Form L-9 Date: ________________ Page ____ of ____ LEA CAPACITY TO SERVE AND SUPPORT SELECTED PRIORITY SCHOOLS This form should ONLY be completed those districts that are applying for more than one (1) Priority School LEA : _____________________________________________________________ Form L-10 Date: ________________ Page ____ of ____ MONITORING AND ACCOUNTABILITY PLAN A monitoring and accountability plan must describe the activities to be undertaken by the district for each school to be served. 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