College Access Challenge Grant (CACG) Program Applicatio

OMB Approval No.: 1840-0802

Expiration Date : ----

U.S. DEPARTMENT OF EDUCATION

COLLEGE ACCESS CHALLENGE GRANT (CACG) PROGRAM

Annual Performance Report

1. PR award Number: _________________________________________________________

(Located in block 5 of your grant award notification)

2. Name of Grantee: ___________________________________________________________

3. Address: __________________________________________________________________

4. Name of Project Director/Contact Person: ________________________________________

Phone Number: ______________________ Fax: ______________________________

E-mail Address: _____________________________________________________________

5. Name of Certifying Official: ___________________________________________________

Phone Number: _______________________ E-mail Address: ______________________

6. Report Period: _____________________________ to ________________________________

Month/Day/Year Month/Day/Year

We certify that to the best of our knowledge, the information reported herein is accurate and complete.

_____________________________________ ______________________________________

Name of Project Director (Print) Name of Certifying Official (Print)

_____________________________________ ______________________________________

Signature and Date Signature and Date

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. Public reporting burden for this collection of information is estimated to average 40 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefit (§781 or Higher Education Act of 1965, as amended). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, DC 20210-4537 or e-mail ICDocketMgr@ed.gov and reference the OMB Control Number 1840-0802. Note: Please do not return the completed annual performance report for the College Access Challenge Grant Program to this address. OMB Approval No.: 1840-NEW

INSTRUCTIONS:

College Access Challenge Grant (CACG) Program grant recipients are required to submit an Annual Performance Report (APR). This report is used by the U.S. Department of Education (ED) to determine if projects funded under CACG are making substantial progress in meeting goals and objectives of the grant, as outlined in grant applications. Please read the following instructions thoroughly to assist you in filling out the required report:

The APR consists of a Cover Page and Two Parts:

The cover page along with Parts 1 and 2 of the APR must be e-mailed to cacgp@ed.gov in Microsoft Word format (*.doc). The actual submission deadlines for Parts 1 and 2 are presented below. Please send a cover sheet, signed by both the project director and certifying official, within three days after electronic submission to the following address:

College Access Challenge Grant Program

U.S. Department of Education

Attn: Karmon Simms-Coates

1990 K Street, NW, Suite 6130

Washington, DC 20006

Ten days prior to the APR submission deadline, you may request permission to mail your APR by e-mailing karmon.simms-coates@ed.gov. In your request you must include the reason why you are unable to submit the APR electronically.

Part 1 – includes the five sections listed below, which address the implementation of services and activities, project administration, and fiscal administration. Part 1 of the APR must be filled out and submitted on or before _______. Part I includes the following sections:

Section I – Executive Summary

Section II – Goals and Objectives

Section III – Administration

Section IV – Budgetary Information

Section V – Services and Activities

Part 2 – collects data relating to CACG program performance measures. In addition to Part 1, Grantees must fill out Part 2 of the APR only if they offered activities and services directly to students in secondary schools and/or provided scholarships to college students. Part 2 must be submitted on or before _____ with a signed cover page.

Grantees are expected to provide clear and concise responses to the APR questions. Please write “Not Applicable” or “N/A” if a question does not pertain to your project. Tables can be expanded to accommodate additional information, however, the contents of the report cannot be modified.

COLLEGE ACCESS CHALLENGE GRANT PROGRAM

PART 1 -- ANNUAL PERFORMANCE REPORT

SECTION I: EXECUTIVE SUMMARY

1. Please provide a brief description (3-4 pages) of the current status of your project. Describe the

extent to which you have implemented all program activities and components planned for this

reporting period. Highlight your major outcomes, successes, and challenges.

SECTION II: GOALS AND OBJECTIVES

1. Describe the progress that your project has made towards accomplishing the objectives of your

project for this reporting period as outlined in your grant application. Please list your objectives in

the table below, and indicate what activities have taken place, the quantitative results of those

activities, and actions required (what, if any, changes do you intend to make in response to the

results that you have seen). You may extend this table to additional pages as needed.

Objectives: List the approved objectives from your grant application or work plan. Where applicable, provide baseline data.	Activities: List the activities that have been conducted to meet the objective.	Results: Has the objective been met? If not, what progress have you made in reaching the objective?	Actions required: Are you planning to make changes to the grant in response to the results?
Example: 1. Enrollment in 7th grade pre-algebra will increase by 5% by next year. Baseline: Pre-algebra 7th grade -- 10%	Example: After school tutoring program.	Example: Enrollment changes from 2008/09 to 2009/10: 1) 7th grade pre-algebra: +65%	Example: Continue to identify students needing intervention services based on achievement scores. Add science component to after school tutoring program.
1.
2.
3.
4.
5.
6.

2. Describe any significant changes in your project design since the approval of your grant application

(e.g., changing from individual tutoring to group tutoring or placing more emphasis on enrichment

activities rather than remediation). Do you anticipate making changes to your project design in the

coming year? If so, please describe. How have any changes or anticipated changes affected your

budget? How will these changes impact quantitative outcomes and your ability to meet the

project’s goals.

SECTION III: ADMINISTRATION

1. Organizational Structure/Capacity

a. How does CACG fit into your organizational structure?

2. What barriers or problems have you encountered in administering your grant, and how have you

addressed these problems?

c. Please list the names and titles of key personnel that are paid by CACG Federal or matching

funds, and indicate the percentage of time each individual spends working on the grant. If the

percentage of time is not available, you may indicate the number of hours for which the

individual was paid.

Name	Title	% of Time	Federal	Non-Federal
			$	$

4. Describe any changes to key personnel of this grant over the past year,

including changes in titles, changes in percentage of time that a person is devoting to the

project, hiring of a key staff person, departure of a key staff person, or addition or elimination of

a position. Discuss any significant changes to key personnel proposed or anticipated for the

coming year. (Please remember that a change in key personnel or the addition or elimination of

position(s) requires prior approval from the Department of Education. To request a change,

please request an administrative action separate from this report. Your response to question

1d. should be a summary of approved and completed changes that have taken place during this

reporting period.)

2. Coordination

1. How did you coordinate CACG activities and services with other programs in your state that assist students in preparing for and graduating from postsecondary education?

3. Sub-Grants

If sub-grants were issued to non-profit organizations, please answer the following questions:

a. How many sub-grants did you issue?

b. Briefly describe any changes that were made to the grant award-making process from what

was outlined in your application.

c. Did you develop written guidelines for sub-grantees to use in implementing grants?

d. How do you monitor the sub-grants?

4. Financial Aid

1. If your project has obligated funds for future distribution of scholarships, loan cancellation or

repayment, or interest rate reductions, please specify a) the purpose, b) the amount of funds that

were obligated, c) whether the funds are Federal or matching contributions, and d) the place where funds are being held pending distribution (e.g., are the funds in a trust account?)

	Purpose	Amount Obligated	Federal or Matching	Placement of Funds
1
2

2. If any funds have been disbursed to students for scholarships, loan cancellation or repayment, or interest rate reductions, please specify a) the purpose, b) the amount of money disbursed, c) whether the funds are Federal or matching contributions, and d) the number of students who benefited.

	Purpose	Amount Disbursed	Federal or Matching	Number of Students
1
2

5. Certifications

Grant recipients must provide certification for the following two requirements. Please indicate ‘yes’ (if the requirement was met) or ‘no’ (if the requirement was not met) by placing an “X” in the appropriate box.

a. Indirect Cost Rate Agreement

Requirement: CACG grantees are required to have a current indirect cost rate agreement

that is approved by the Federal government in order to charge indirect costs

to the grant.

Yes	No	Certification
		The fiscal agency of the CACG grant has a current indirect cost rate agreement.

If this requirement has not been met, please explain below.

b. Maintenance of Effort

Requirement: For any academic year beginning on or after July 1, 2008, States are required to:

1. Provide for public institutions of higher education an amount which is equal to or greater than the average amount provided for non-capital and non-direct research and development expenses or costs by the State to such institutions during the five most recent preceding academic years, and

2. Provide for private institutions of higher education an amount which is equal to or greater than the average amount provided for student financial aid for paying costs associated with postsecondary education by the State to such institutions during the five most recent preceding academic years.

Provide the following State fiscal data with a certification of its accuracy by the State budget office or an authorized representative thereof. Amounts should be shown in whole dollars.

Total State Appropriations for Public Institutions of Higher Education (excluding capital expenditures and research and development)
2005
2006
2007
2008
2009
2010

If your State appropriates funds separately for use at private IHEs:

Total State Appropriations for Financial Aid for Students Attending Private IHEs
2005
2006
2007
2008
2009
2010

If your State does not have control over the types of institutions (e.g. public, private) at which student aid is used:

Total State Appropriations for Student Financial Aid
2005
2006
2007
2008
2009
2010

Total State Expenditures for Financial Aid for Students Attending Private IHEs
2005
2006
2007
2008
2009
2010

Yes	No
		The State certifies that, in State fiscal year 2010, it provided for public institutions of higher education in the State an amount of funding which was equal to or greater than the average amount provided for non-capital and non-direct research and development expenses or costs by the State to such institutions of higher education during the five most recent preceding academic years for which satisfactory data are available.
		The State certifies that, in State fiscal year 2010, it provided for private institutions of higher education in the State an amount of funding which was equal to or greater than the average amount provided for student financial aid for paying costs associated with postsecondary education by the State to such institutions during the five most recent preceding academic years for which satisfactory data are available.

If you answered "NO” to either certification above:

Yes	No
		The State is requesting a waiver of its statutory maintenance of effort requirements pursuant to 20 U.S.C. §1015f. The State understands that (a) without the granting of a waiver, the State will be unable to receive its FY 2011 CACG award, and (b) the submission of a waiver request does not indicate that such a request will be granted.

If you answered “YES” to the question above and are requesting a waiver of the statutory maintenance of effort requirements, provide the following data, with a certification of its accuracy by the State budget officer or an authorized representative thereof. Amounts should be shown in whole dollars.

	2005	2006	2007	2008	2009	2010
Total State revenues
Total State appropriations
Total State expenditures

By signing below, the State Budget Officer or authorized representative certifies that the fiscal data included in this section regarding the State’s appropriations, expenditures and revenues is complete and accurate.

__________________________________________________

State Budget Officer or Authorized Representative (Printed Name)

_______________________________________________________ _______________

Signature of State Budget Officer or Authorized Representative Date

SECTION IV – BUDGETARY INFORMATION

1. In the following table, please provide information about your actual and anticipated Federal

expenditures for the current budget period. You do not need to fill in the shaded boxes, but please

indicate total amounts in line D for all columns.

Federal Budget Summary

	Federal Funds Awarded	Actual Federal Expenditures for ? - ? of Current Budget Period	Anticipated Federal Expenditures for ? –? of Current Budget Period	Anticipated Carryover to Next Budget Period (if applicable)
Salaries and Wages
Employee Benefits
Travel
Materials & Supplies
Consultants & Contracts
Other
Total Direct Costs: (Lines 1 – 6)
Total Indirect Costs:
Equipment
D. *Scholarships/ Tuition Assistance
D. Total Costs (A+B+C+D)

* The scholarships/tuition assistance line item also includes loan cancellation, loan repayment, and interest rate reduction.

2. In the following table, provide information about your actual and anticipated non-Federal matching

contributions for the current budget period:

Non-Federal Budget Summary

	Matching Contributions Proposed For Current Budget Period (September-August)	Actual Matching Contributions for September-March of Current Budget Period	Anticipated Matching Contributions for April –August of Current Budget Period	Anticipated Carryover to Next Budget Period, if applicable
1. Salaries and Wages
2. Employee Benefits
3.Travel
4. Materials & Supplies
5. Consultants & Contracts
6. Other
A. Total Direct Costs: (Lines 1 – 6)
B. Total Indirect Costs:
C. Equipment
D. *Scholarships/ Tuition Assistance
E. TOTAL COSTS (A+B+C+D)

* The scholarships/tuition assistance line item also includes loan cancellation, loan repayment, and interest rate reduction.

3. Please fill out the table below representing “actual” federal and matching expenditures for the

previous year. If you are reporting on the first year of implementation, you do not need to fill out

this table.

	Actual Federal Expenditures Year 1	Actual Matching Contributions Year 1
1. Salaries and Wages
2. Employee Benefits
3. Travel
4. Materials & Supplies
5. Consultants & Contracts
6. Other
A. Total Direct Costs: (Add lines 1-6)
B. Total Indirect Costs
C. Equipment Purchase
D. *Scholarships/ Tuition Assistance
E. TOTAL COSTS (A+B+C+D)

* The scholarships/tuition assistance line item also includes loan cancellation, loan repayment, and interest rate reduction.

4. Please describe any changes made to your budget with respect to either Federal or matching funds.

5. Please describe how you plan to expend any carryover funds.

6. Please provide a list of matching sources, such as State appropriations, non-profit organizations,

local government entities, institutions of higher education, other public or private organizations.

	Source	Amount Contributed	Briefly describe the type of contribution
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

SECTION V: SERVICES/ACTIVITIES

1. Please enter the number of students who participated in CACG activities or received services.

Number of Students: ________

2. Services Provided to Students: In the following table, place an “X” in the first column next to the

types of services or activities provided by your project with Federal or matching funds. For each

type of service provided, indicate the number of students who received the service during the

reporting period.

Place an “X” in this column if your project provides this type of service	Type of Service/Activities	Number of Students
	Information for students and families (i.e., postsecondary education benefits, opportunities, planning, financial options, and college preparation)
	Outreach activities
	Assistance in completion of FAFSA or other financial reporting forms
	Need-based grant aid
	Academic enrichment
	Loan cancellation, repayment, or interest rate reduction
	Other (please specify)

3. Professional Development

a. Please enter the number of guidance counselors at middle and secondary schools, financial aid

administrators, and/or college admissions counselors at an institution of higher education that

participated in professional development activities.

Category	Number of Participants
Middle or High School Counselors
Financial Aid Administrators
College Admissions Counselors

b. Please describe briefly the type of professional development activities that were implemented

(e.g., workshops and/or materials).

COLLEGE ACCESS CHALLENGE GRANT PROGRAM

PART 2 - ANNUAL PERFORMANCE REPORT

Grantees must fill out and submit Part 2 of the APR only if they offered activities and services directly to students in secondary schools and/or provided scholarships to college students. Part 2 must be submitted on or before ______.

1. If your project offers activities and services directly to students in secondary schools:

a. Please provide the number of high school seniors who received services as a result of the CACG

grant in the 2008-2009 academic year. Note: If secondary school guidance counselors were

provided professional development in applying for federal student financial assistance, include

all of the high school seniors at the guidance counselors’ target school(s).

Number of Students

b. Please provide the number of high school seniors who completed a Free Application for Federal

Student Aid (FAFSA) in the 2008-2009 academic year.

Number of Students

2. If your project has a scholarship (need-based grant aid) program, please provide the following

information for the 2008-2009 academic year .

a. Number of high school seniors who were offered a CACG scholarship with Federal

funds. ______

2. Total cost of CACG scholarships offered to high school seniors with Federal funds for their first year of postsecondary education with federal funds. _________

3. Number of high school seniors who were offered a CACG scholarship with Federal funds and

enrolled in postsecondary education within one year of high school graduation. _______

d. Number of college freshmen who received a CACG scholarship with Federal funds. ________

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