21CCLC Request for Applications

Important!  Do not use your browser’s back, forward, or refresh buttons. You will lose your progress on your application. Only use the navigation below and the “continue” buttons at the bottom of each page to navigate the application form. Your information will not be saved if you leave this page.

Ready to submit your application?

 

Please review your application to ensure you have filled out the entire form.
The button to submit your application is available at the bottom of this page. 

Application Information

Director of Agency:

Is the Grant Contact/Project Director the same contact as the Director of Agency?

Grant Contact/Project Director: 

Data Collection and Evaluation Contact:

Fiscal Contact (your school or organization's Chief Financial Officer/Business Manager):

Are you a past grantee?

Only past grantees are required to fill out this section. 

Please respond to the following questions.

ESSA 4203(14) describes how the State educational agency will evaluate the effectiveness of programs and activities carried out under this part. ESSA 4204.2 (E) a description of how the activities will meet the measures of effectiveness described in section 4205(b); ESSA 4205(1) IN GENERAL.—For a program or activity developed pursuant to this part to meet the measures of effectiveness, monitored by the State educational agency as described in section 4203(a)(14).

Section 4204.4(J) of the ESEA authorizes SEAs to renew sub-grants awarded to eligible entities under ESSA, “based on the eligible entity’s performance during the preceding subgrant period.” Based on the plain meaning of the language of this provision, SEAs have discretion to renew sub-grants that they award to eligible entities under ESSA, provided that the eligible entity’s performance under the preceding subgrant was satisfactory. Under section 312 of the Department of Education Appropriations Act, 2016, the provisions of ESSA apply to 21stCCLC program sub-grants awarded during the 2017-18 school year and later years. Therefore, SEAs may renew21stCCLC program sub-grants awarded on or after July 1, 2017. Under the orderly transition authority of ESSA, ED authorizes SEAs to renew sub-grants awarded under the ESEA, as amended by NCLB prior to July 1, 2017. Limitation: Renew current sub-grants one time for one to five years, consistent with the terms of the original subgrant’s performance period. Example: If a grant has an original performance period of 5 years, that grant may be renewed up to an additional 5 years, not to exceed a total of 10 years.

Have you ever been in non-compliance (received a letter notice from Iowa Department of Education stating non-compliance) with 21CCLC rules and regulations in the past three years? 
Did you meet your attendance goals for the past two years? (21CCLC funded sites are required to meet their attendance goals at a rate of 70% in year one and 80% by year three)
Did you meet your academic goals for the past two years?
How many of your local evaluation goals did you meet over the past two years?
How much have office referrals been reduced over the past five years of your grant?
Have you provided children with the required snack?
Have you exceeded the snack requirement, by providing a full meal?
Are you charging program fees to families?
After 5 years, how many community partners for sustainability have been recruited?
Have you participated in required committee work in the last year? Attended:
Have you attended required Professional Development in the last year? Attended:

These questions provide data on the effectiveness of an existing program. Monitored as required by ESSA and the Iowa Grant Agreement Performance Monitoring section. 

Forms

Legal Status of Applicant* 

Please download the "Legal Status of Applicant" document, fill out the form, and upload the complete form using the button below. 


Supported formats: Word or PDF

Upload Completed Form

Collaborative Signatures *

Please download the "Collaborative Signatures" document, fill out the form, and upload the complete form using the button below. 
 

Supported formats: Word or PDF

Request for Competitive Priority*

It is the responsibility of the applicant to request and provide documentation of competitive priority in scoring of applications. In the downloadable form, please check the boxes for priority you are requesting and provide explanation of the documentation provided to substantiate your request. Examples of documentation are provided. 

 

Please download the "Request for Competitive Priority" document, fill out the form, and upload the complete form using the button below. 

Supported formats: Word or PDF

Upload Completed Form

Minority Impact Statement*

Please download the "Minority Impact Statement" document, fill out the form, and upload the complete form using the button below.  

Supported formats: Word or PDF

Upload Completed Form

Private School Consultation Meeting Log*

Please download the "Private School Consultation Meeting Log" document, fill out the form, and upload the complete form using the button below.

Supported formats: Word or PDF

Upload Completed Form

Sustainability Planning Template and Previous Sustainability Form*

Sustainability Plan*

Please download the "Sustainability Plan Form" document, fill out the form, and upload the complete form using the button below. 

Supported formats: Word or PDF

Upload Completed Form

Past Grantee Sustainability Form

Existing 21st Century Community Learning Center programs are required to document efforts of sustainability according to federal law. This template serves as an opportunity for existing 21st Century Community Learning Centers grantees to document what partners have committed to support through financial contributions, in-kind donations, volunteer time, and other goods and services. A lack of evidence of sustainability will be considered supplanting and will not be funded. 

Supported formats: Word or PDF. Only submit if you're a past grantee. 

Upload Completed Form

Community Partner Official Notice

Districts that are eligible for a community partner to apply in a high need urban area MUST provide the Iowa Department of Education with official notice of who that partner will be and a description of the partnership and how it will benefit at-risk children in the community. 

Failure to provide this official notice will result in ONLY the district application being accepted for grant review. The Community Partner application will not be read but will have the option of re-applying the following year. 

Required for community-based organizations only. 

Supported formats: Word or PDF

Upload Completed Form

Assurances & Agreements Required of All Applicants*

Please download the "Assurances & Agreements" document, fill out the form, and upload the complete form using the button below. 

Supported formats: Word or PDF

Upload Completed Form
Upload Completed Form

MOU Template*

Please download the "MOU Template" document, fill out the form, and upload each completed form using the button below. Please upload at least 5 and up to 10 MOUs.

 

Supported formats: Word or PDF

Upload MOU
Upload MOU
Upload MOU
Upload MOU
Upload MOU
Upload MOU
Upload MOU
Upload MOU
Upload MOU
Upload MOU

Site Information 

2022-2025 Site Profile 

Target Schools*

School-Wide Information 
# of Youth to be Served

Grades Served by School 

Total Enrollment 

Free and Reduced Lunch Rate 

Grades Served by Program 

BS

AS

School Name
(can apply for up to 3 sites) 

SUM

TOTAL

Before School (BS) Site Operations*

Please mark each field NA if it does not apply to your site.
 

Monday 

Tuesday

Wednesday

Thursday

Friday

Saturday

Start Time 

End Time 

Hours 

After School (AS) Site Operations*
Please mark each field NA if it does not apply to your site.

Monday 

Tuesday

Wednesday

Thursday

Friday

Saturday

Start Time 

End Time 

Hours 

Summer (SUM) Site Operations*
Please mark each field NA if it does not apply to your site.

Monday 

Tuesday

Wednesday

Thursday

Friday

Saturday

Start Time 

End Time 

Hours 

Family Engagement* 

All 21CCLC programs are required to host a minimum of four family-centered events each year. A general rule of thumb is one per quarter. Examples of events include back-to-school celebrations, literacy nights, family game nights, recreational events, guest speakers, and so on.

Total Number of Family Events*
School Name
Estimated Total Number of Adult Family Members Served:*

Financials

Funding Estimator 

The Funding Estimator is provided as an Excel document and is designed to be a tool to determine the amount of funding needed to implement a successful program. The funding estimator does not need to be uploaded. It is just a resource. This tool is designed to assist you in determining an appropriate budget request. Your partner contributions should be documented and deducted from your accounting for an accurate estimation of request.

Form D1: 21CCLC Application Funding Request Summary
 

21CCLC TOTAL FUNDING REQUEST*

(Before and/or After School and Summer Program Funds) 

FUNDING FOR EACH SITE INCLUDED IN THIS APPLICATION*

NOTE: A program site may serve students from many schools. For example, a location that serves students from three (3) different schools would be considered one Program Site. 

Name of Program Site(s) 
Year 1 Funding Request 
Year 2 Funding Request 
Year 3 Funding Request 
Total Funding Request 
(3-year total) 
Number of Students Served per site per year 
Name of Program Site(s) 
Year 1 Funding Request 
Year 2 Funding Request 
Year 3 Funding Request 
Total Funding Request 
(3-year total) 
Number of Students Served per site per year 

Form D2

Please submit a single spreadsheet with all your D2 forms tabulated. You must complete a form for each site you will operate under your 21CCLC grant.

Upload Completed Form

Form D3

Please submit a single spreadsheet for your Form D3. This form is new this year and provides a summary of your 21st Century expenditures and partner contributions. You are only required to submit Year 1 of this form. The other tabs in the spreadsheet are provided for your information. 

 

2 CFR 200.331(b) requires states to conduct a risk assessment- Each Quarter your claim is reviewed for the amount (over or below quarterly average) and for restricted categories (like PD). We are adding a quarterly attendance check. Your D1 number is the number of students you proposed to serve and are receiving federal funds for. The Enrollment number is the actual number of students. The average daily attendance shows how many attend on a regular basis. 

The Grant Application requires you to serve 70% of the D1 number by the end of year 1. The Grant Application requires you to serve 80% of the D1 number by the end of year 3. 

If your recruiting methods are effective and you maintain a student leadership group and engage them with telling other students about the activities offered in afterschool, you should have no trouble meeting this goal. 

If your program provides engaging activities and you develop positive relationships with the students, you should have no trouble with increasing regular attendance (even with a history of chronic absenteeism). 

If you are having trouble with meeting your goals, you are responsible to contact the SEA for help. (email: vic.jaras@iowa.gov). There are many options that can help increase enrollment, attendance and decrease referrals in this program. 

Failure to meet your attendance goals can result in a reduction in your federal funding. Your award for the following year may be reduced due to insufficient attendance this year. 

Upload Completed Form

Form D4: Applicant Agency’s Fiscal Resource Information 

It is recommended that each applicant, including school districts, public entities, or government agencies, possess sufficient fiscal resources in order to start up and operate the program being requested for a period of up to three months. Please indicate if you are a public entity or a private/non-profit by checking the appropriate box below and then use the text box at the bottom of the page to answer the questions regarding fiscal resources for start-up costs and operational costs. 

In the textbox below, please describe your funding sources that can be used to start up and operate the program for up to three months. For example, public entities should include their budget line item number, account numbers, or any other applicable references. Private organizations should describe cash, lines of credit, emergency loans, etc. Fiscal resource information should be specific (e.g., bank or lender names; name of the holder of the account).

 

* Note: If you do not have the financial resources available equal to the amount of funding you are requesting, you do not have the financial capacity for this project. Agencies that do not have adequate fiscal resources on hand are eligible to participate in the application process. However, the applicant must describe in this section the agency’s plan to secure the necessary fiscal resources for this program application. 

* Note: Agencies must validate their resources before any award can be made. 

Summer School

School Year

Basic Service Components

School or Site/Building Name:
School or Site/Building Name:
School or Site/Building Name:

If location for the program is different from the school where children attend, list both below:

Do you plan to provide any of the following to meet the nutrition/food access needs of students? (Check or highlight all that apply):
Do you plan to follow best practices?

Proposal Narrative

 

We STRONGLY encourage you to save the narrative sections of this application in a Word Document since you cannot save your grant progress and come back to it later. Character limits are noted for each section (4,000 characters is the equivalent to one page of text in Arial size 12 font). 

Abstract (Not scored)

The abstract should include summaries of each of the narrative sections and provide documentation of competitive priority status, if being requested.

The number of students served:
The total amount requested per year:
The total amount per student :

Character limit: 8,000 (including spaces). Please note that some features like tabbing, inserting tables and graphics, and hyperlinks are unavailable.


Student Needs Assessments (20 possible points) 

This section describes in detail the needs assessment, objective data, and resources available as well as a description of how these conclusions were reached. This section should include: 

  • Strong evidence utilizing objective data that very clearly defines the student need for a before and/or after school program (may include weekends, holiday and summer).

  • An evaluation of school and community resources available (including other accessible before and after school programming), and convincingly documents how proposed program will address student needs (including needs of students with working families). 

  • Evidence of how stakeholders (youth, parents, and partners) were identified and the results of those discussions that led to your decision to apply for funds and program development. Example: survey, focus groups, interviews.

  • A description of the impact you are going to make with the youth to be served.

  • Title program data.

  • Achievement gap information.

  • Total student population and the number you plan to serve from each school/site.

  • A summary of transportation, safety, and accessibility components.

NOTE: The 21CCLC program puts forth sound measures of effectiveness to guide local grantees. All programs must indicate how each program activity satisfies the Measures of Effectiveness described in the law. For a program or activity to be compliant with this component of the law, monitored by the SEA as d