Apr 2013

OMB Approval No.: 1840-0777

Expiration Date: 01/31/2013

U.S. DEPARTMENT OF EDUCATION

Gaining Early Awareness and Readiness for Undergraduate Programs

(GEAR UP)

Annual Performance Report for Partnership and State Projects

COVER SHEET

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 it displays a valid OMB control number. The valid OMB control number for this information collection is 1840-0777. The time required to complete this information collection is estimated to average 40 hours per response, including the time to review instructions, search existing data sources, 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, DC 20202-4651. If you have comments or concerns regarding the status of your individual submission of the form, write directly to: The GEAR UP Program, U.S. Department of Education, 1990 K Street, N.W., 7014, Washington, DC 20006-8524.

INSTRUCTIONS:

The following set of forms are the Annual Performance Report (APR) for GEAR UP State and Partnership projects. The APR is used by the Department of Education to determine whether substantial progress is met when meeting the objectives of your project as outlined in your grant application and/or work plan for this reporting period. Under section 75.590 of Education Department General Administrative Regulations (EDGAR), each eligible recipient that is awarded a GEAR UP grant must submit an APR describing their progress in meeting project goals and objectives. As required by the Government Performance and Results Act of 1993, the APR is also used to collect data addressing the performance of the GEAR UP program on a national level. Annual submission of the APR is a requirement of your grant and will be used to determine continuation of funding.

The APR consists of a cover sheet and six sections. The cover sheet must be completed and signed by the project director and the certifying official and returned to the Department of Education along with the six sections on or before the due date. A separate announcement including these instructions and due date will be mailed to each grantee annually. Grantees are expected to complete all questions in the APR. Please define all terms specific to your program and spell out all acronyms the first time they are used.

Except where otherwise indicated, the reporting period for this report is as follows:

• If this is the first award year of your grant, the reporting period includes the time period from the beginning of your grant through March 31^st of this year.

• If this is the second through sixth or seventh award year of your grant, the reporting period includes the period of time from the end of your last reporting period through March 31^st of this year.

SECTION I: EXECUTIVE SUMMARY

1. Please provide a brief description (1-2 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 concerns.

SECTION II: NARRATIVE INFORMATION

1. The mission of the GEAR UP program is to significantly increase the number of low-income students who are prepared to enter and succeed in postsecondary education. Briefly describe how your project is furthering the mission of the GEAR UP program. Specifically, address how your project is: a) improving academic performance of students in the GEAR UP cohort; b) increasing educational expectations of participating students and their parents; c) improving student and family knowledge regarding postsecondary education preparation and financing; and d) working to improve high school graduation and college enrollment rates.

2. What aspects of your program do you think are most successful (have the greatest impact)? Why?

3. What barriers or problems have you encountered in planning, developing, implementing,

and/or administering your grant? How have you addressed these problems?

4. Describe briefly the progress that you have made during this reporting period in implementing your evaluation plan as described in your approved application for GEAR UP funding.

5. Describe how your project’s activities and outcomes are likely to be sustained over time. What systemic changes have occurred in your school(s)?

6. Please provide any additional information about your project that you think would be helpful to the Department of Education in evaluating your performance or understanding the contents of your annual report.

7. 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 or work plan. 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 on to another page 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, 8th grade algebra, and 8th grade advanced science classes will increase by 5% by next year. Baseline: Pre-algebra 7th grade -- 10% Algebra 8th grade -- 5% Adv. Sci. 8th grade -- 20%	Example: Instructional support services, staff development to improve instruction, and articulation with elementary schools	Example: Enrollment changes from 2008/09 to 2009/10: 1) 7th grade pre-algebra: +65% 2) 8th grade algebra: +5% 3) 8th grade advanced science: -6% (due to increased standards for enrollment).	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.
7.
8.

SECTION III: GRANT ADMINISTRATION AND BUDGET INFORMATION

1. In the following table, please provide information about your actual and anticipated Federal expenditures for the current budget period. The current budget period can be found in Section 6 of your current Grant Award Notification (GAN). You do not need to fill in the shaded boxes, but please indicate total amounts in line E for all columns. *If this is the first award year of your grant, the reporting period includes the time period from the beginning of your grant through March 31 ^st of this year.

Federal Budget Summary

	Total Federal Funds Awarded for Current Budget Period (See Current GAN)	Carryover Funds Available (Include Funds Carried Over From Previous Budget Period(s))	Actual Federal Expenditures from Current Budget Period (GAN Start Date) thru March of APR Submission Year	Anticipated Federal Expenditures from April to Current Budget Period End Date	Anticipated Carryover to Next Budget Period (if applicable)
Salaries and Wages
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)

2. In the following table, provide information about your actual and anticipated non-Federal matching contributions for the current budget period. Current budget period can be found

in Section 6 of your current Grant Award Notification (GAN). *If this is the first award year of your grant, the reporting period includes the time period from the beginning of your grant through March 31 ^st of this year.

Non-Federal Matching Budget Summary

	Matching Contributions Proposed For Current Budget Period (See Current GAN)	Actual Matching Contributions for Current Budget Period April – March*	Anticipated Matching Contributions from April to Current Budget Period End Date
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)

 If you requested a match reduction in your original application, please check the box.

3. In the following table, please provide information about your actual Federal and matching expenditures for previous, completed budget periods. For example, for grants that began in Fiscal Year 2009, the Year 1 budget period would be July 2009 through June 2010. First year grantees do not need to fill out this table. If you are in the second through seventh years of your grant, fill out information only for completed budget periods.

Actual Federal Expenditures Year 1

Actual Matching Contributions Year 1

Actual Federal Expenditures Year 2

Actual Matching Contributions Year 2

Actual Federal Expenditures Year 3

Actual Matching Contributions Year 3

Actual Federal Expenditures Year 4

Actual Matching Contributions Year 4

Actual Federal Expenditures Year 5

Actual Matching Contributions Year 5

Actual Federal Expenditures Year 6

Actual Matching Contributions Year 6

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

D. Scholarships/ Tuition Assistance

E. TOTAL COSTS (A+B+C+D)

4. If you are not expending Federal or matching funds as originally budgeted, please provide an explanation for the change. Please describe how you plan to expend carryover funds and/or how you plan to meet your matching requirements.

4. 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?

4. Please list the names and titles of all individuals paid by GEAR UP Federal or matching funds, and indicate the percentage of time each individual spends working on the GEAR UP grant. (If the percentage of time is not available, you may indicate the number of hours that individual was paid with GEAR UP funds instead.)

4. Describe any changes to key personnel of this grant that have come about 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 reporting period. (Do not request replacement of key personnel or the addition / elimination of position(s) here. That type of request is a change that requires an administrative action and must be addressed separate from this report. Your response should be a summary of approved and completed changes that have take place during this reporting period.)

4. Describe any changes to the roles of your partners during the past year. Have any partners been added to your grant? Have any partners discontinued their participation in your grant? Has the role of any existing partner changed significantly?

4. Describe briefly your project’s record keeping system for collecting and reporting student outcome/achievement data and participation in GEAR UP activities. Specifically, how frequently are data collected, and what method(s) does your project use to collect and maintain data regarding student, parent, and teacher participation in GEAR UP activities?

4. How do you link student outcome/achievement data with student participation? How does your project use the data collected to evaluate and guide the project?

4. Describe your record-keeping system for maintaining source documentation for all federal and non-federal expenditures (e.g., time and effort record (which include percentage of time spent on grant activities), transportation cost, equipment, supplies, college field trips, and other GEAR UP expenditures). Who is responsible for maintaining the documentation?

4. If your project has a scholarship component for postsecondary education, please provide: a) information about the amount of scholarship money (Federal and/ or non-Federal matching funds) that has been reserved and/or obligated; b) information regarding where scholarship funds are held pending distribution to former GEAR UP students (e.g., are the funds in a trust account?); and c) how the funds will be disbursed and to whom. If you have already disbursed scholarship money to students, please indicate the amount of money disbursed, the number of students who received scholarships, and the average amount of the scholarships awarded. NOTE: Scholarship funds are subject to audits or monitoring by authorized representatives of the Secretary throughout the life of the funds.

4. Please indicate the number of GEAR UP 12^th grade students who have completed the Free Application for Federal Student Aid (FAFSA) - ______ (number of students).

4. Please complete the following table. List all partners and indicate with an “X” whether they are original partners listed in the application or new partners added during implementation. If any of these partners have become inactive and are no longer participating in the grant, please indicate this with an “X” in the column provided. If a partner is new, indicate with an “X” if you have provided the program office with a Partner Identification Form and Cost Share Worksheet to update the application.

Rows can be added to this table if you have more partners.

	Partner Name	Original	New	Inactive	Submitted Partner Identification Form and Cost Share Worksheet	Type of Partner (IHE)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Please indicate the type of partner from the following options and enter the letter in the column provided:

C = Community Organization, F = Faith-based Organization, B = Historically Black College and University

(HBCU), H = Hispanic Serving Institution (HIS), O = Other Type of Organization, P = Other Postsecondary Institute, and S = School/District, IHE= Institute of Higher Education.

15. Indirect Cost Agreement: Indirect cost reimbursement on a training grant is limited to the recipient’s actual indirect costs, as determined by its negotiated indirect cost rate agreement, or eight percent of the modified total cost base, whichever amount is less. In order to claim an indirect cost on next year’s budget, the grantee must provide information on their current agreement. Check one of the three options.

1.  Current Indirect Cost Agreement: Effective date of agreement: Beginning date: _____

Ending date: _________, Current rate:_________

2.  Requesting indirect Cost Agreement: If you’ve requested an indirect cost rate agreement

but have not receive one, you should provide your program officer with evidence of your contact with the cognizant agency and their response. If a negotiated indirect cost rate agreement was not awarded, a grantee using the training rate of eight percent is required to have documentation available for audit that shows that its indirect rate equals or exceeds the eight percent. Please indicate whether your program officer has documentation of your attempt to secure an indirect cost rate agreement Yes  No 

3.  Do not claim indirect cost.

16. Scholarship Funds: Please report on all Federal and non-Federal funds reserved and held for GEAR UP

Scholarships and the disbursement of those scholarship funds to eligible students. NOTE: Scholarship

funds are subject to audits or monitoring by authorized representatives of the Secretary

throughout the life of the funds.

1. Federal Scholarship Funds:

$________________: Amount of funds reserved for GEAR UP students

$________________: Amount of funds disbursed to GEAR UP students

$________________: Total number of students receiving scholarships

$________________: Amount of unexpended funds to be returned to the Department

2. Non-Federal Scholarship Funds:

$________________: Amount of funds reserved for GEAR UP students

$________________: Amount of fund disbursed to GEAR UP students

$________________: Total number of students receiving scholarships

SECTION IV: DEMOGRAPHIC DATA AND DATA REGARDING SERVICES PROVIDED

1. Demographic Data: Please complete the following tables requesting demographic data on GEAR UP students.

1. Students Served: Please complete the following table indicating the number of students served by your project.

	Number of Students
Number of students you proposed to serve during the reporting period (information supplied from application by the program office)
Actual number of students in your cohort(s) during the reporting period (i.e., number of students served)

State grants only: If you are serving students through a statewide initiative please indicate that number here. These numbers do not include those students stated on the Student Served Form in your proposal and reported in the actual students served count shown above.
(An example of this may be a statewide homework hotline where students can call in and receive assistance with their assignments.)

Number of Students served under statewide initiatives________

2. Participant Distribution by Ethnic Background: The following table regarding the ethnicity/race background of GEAR UP students is mandatory and will be used by the Department of Education in reporting on the ethnicity/race characteristics of students served by the program. The ethnicity/race categories used in this section are consistent with the Department of Education’s policy on the collection of racial and ethnic information. These categories are defined as follows:

1. Ethnicity

Hispanic or Latino – A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

2. Race

American Indian or Alaska Native – A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliations or community recognition.

Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, and the Indian subcontinent. This area includes, for example, China, India, Japan, Korea, and the Philippine Islands.

Black or African American – A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii or other pacific islands such as Samoa and Guam.

White – A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.

Two or more races

Ethnicity and/or Race Unknown

Ethnicity:	Number of GEAR UP Students
Hispanic or Latino
Race:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Two or More Races
Race and/or Ethnicity Unknown
Total

3. Participation by Gender: Complete the following table regarding the gender of GEAR UP students.

Gender:	Number of GEAR UP students
Male
Female
Total Students Served (should equal total number of students in cohort in Section IV, 1A)

D. Participant Distribution by Grade and New or Continuing Status: Please complete the following table indicating the number of students in each grade that are new to GEAR UP (received GEAR UP services for the first time during the reporting period) and the number of current students who are continuing (received GEAR UP services during a prior period).

Grade Level:	Number of New GEAR UP Students	Number of Continuing GEAR UP Students
K-4
5
6
7
8
9
10
11
12
First Year IHE Enrollment
Total

5. Participants with Limited English Proficiency: Completion of this table is not mandatory but is extremely helpful to the Department of Education in reporting on the characteristics of students served by the GEAR UP program. If you choose to do so, please complete the following table indicating the number of GEAR UP students with Limited English Proficiency served by your project during the reporting period.

Limited English Proficiency: For the purposes of this table, Limited English Proficiency means a person whose native language is other than English and who has sufficient difficulty speaking, reading, writing, or understanding the English language to deny that individual the opportunity to learn successfully in classrooms in which English is the language of instruction.

	Number of GEAR UP Students
GEAR UP students with Limited English Proficiency

5. Participants with Individualized Education Programs (IEPs) as Required by the Individuals with Disabilities in Education Act Amendment of 1997 (IDEA): Completion of this table is not mandatory but is extremely helpful to the Department of Education in reporting on the characteristics of students served by the GEAR UP program. If you choose to do so, please complete the following table indicating the number of GEAR UP students with Individualized Education Programs.

	Number of GEAR UP Students
GEAR UP students with Individualized Education Programs

2. Participating Schools and Housing Projects: Please complete the appropriate table below indicating the schools or housing projects participating in your grant.

1. Participating Schools: If your grant is a partnership grant using a cohort model, please list all of the schools participating in your GEAR UP project. A participating school is a partner school identified in your GEAR UP application or is a school in which GEAR UP services are provided. Please include all schools you identified in your application, even if they do not yet have students participating in GEAR UP (e.g., if the GEAR UP cohort consists of 7^th graders, please list the GEAR UP high school(s) that the students will attend). In appropriate boxes, indicate all relevant grade levels separated by commas (e.g., 6, 7, 8). State grants and partnership grants using a public housing model do not need to complete this table.

Name of School	Grade Levels Offered	Grade Levels Served by GEAR UP	Percentage of Students Eligible for Free and Reduced Price Lunch	City	State	Zip Code

B. Participating Housing Projects: Complete this table only if your project uses a public housing model. If your project is serving a public housing authority, please provide the name(s) of the public housing project(s). Indicate grade levels separated by commas (e.g., 6, 7, 8).

Name of Public Housing Project	Grade Levels Served by GEAR UP	City	State	Zip Code

C. State Grants only: Number of Schools Participating in State GEAR UP Projects Please indicate the number of schools participating in your GEAR UP project during the current year. Partnership grants do not complete this table.

Number of Schools Participating in the State GEAR UP Project

3. Services Provided to Students: In the following table, place an “X” in the first column next to the types of services provided by your project with GEAR UP Federal or matching funds. For each type of service provided, indicate the number of students who received the service during the reporting period and the average number of hours of service provided per student during the reporting period.

Place an “X” in this column if your project provides this type of service	Type of Service R= Required Activity	Number of Students in the GEAR UP Cohort Who Received the Service	Average Hours of Service Per Participant Receiving the Service Per Year
	Supportive Services (R)
	Rigorous academic curricula (R)
	Comprehensive Mentoring (R)
	Financial aid counseling/ advising (R)
	Counseling/ advising/ academic planning/career counseling (R)
	College visit/college student shadowing
	Job site visit/job shadowing
	Summer programs
	Educational field trips
	Workshops
	Family/cultural events
	Other (please specify)

4. Services Provided to Parents: In the following table, place an “X” in the first column next to the types of services provided by your project using GEAR UP Federal or matching funding. For each type of service provided, indicate the number of parents (or guardians) who received the service during the reporting period and the average number of hours of service provided per parent during the reporting period.

Place an “X” in this column if your project provides this type of service	Type of Service	Number of Parents of Students in the GEAR UP Cohort Who Received the Service	Average Hours of Service Per Participant Receiving the Service Per Year
	Workshops on college preparation/financial aid
	Counseling/advising
	College visits
	Family events
	Other (please specify)

5. Services Provided to Teachers: Please complete the following table indicating professional development provided to GEAR UP teachers. Include all teachers who taught GEAR UP students, whether or not their salaries are paid using GEAR UP funding.

Number of Teachers Who Taught GEAR UP Students During the Reporting Period	Number of Teachers of GEAR UP Students Who Participated in GEAR UP Sponsored Professional Development During the Reporting Period (April through March)	Average Hours of Professional Development Per Participating Teacher During the Reporting Period

6. Services Provided to Schools: Please complete the following table indicating services provided to GEAR UP schools.

Place an “X” in this column if your project provides this type of service	Type of Service
	Curriculum development
	Dual or current enrollment programs
	Other (please specify)

SECTION V: GEAR UP STUDENT OUTCOMES

This section of the report requests outcome information for current participants. Please report on your current GEAR UP students’ grades as of the time this report is submitted. Grantees are not required to report end of the year school grades.

1. Students Enrolled in Advanced Courses by Grade Level: Please complete the following table indicating the number of current GEAR UP students enrolled in advanced courses. “Advanced courses” are classes that are identified as above grade level by the student’s school. If an advanced course is not offered, please respond “N/A”.

Current grade level	Number of Students Enrolled in Advanced Mathematics Courses	Number of Students Enrolled in Advanced English/Language Arts Courses	Number of Students Enrolled in Advanced Science Courses
6
7
8
9
10
11
12
First year IHE
Total

2. Course Completion: Please complete the following table indicating the number of GEAR UP students who have successfully completed the courses identified. The names for math classes can vary among schools. Classify courses based on the content of the course. “Advanced Placement” classes are courses designed to prepare students for the Advanced Placement Exams. Grantees in their first year do not need to complete this question. Enter the numbers in the grade level the cohort was in when the course was completed.

Grade student was in when course was completed	Pre-algebra	Algebra I or equivalent	Geometry	Algebra II	Calculus	Chemistry	Physics	At least one Advanced Placement class
6
7
8
9
10
11
12
First Year IHE
Total

Grade student was in when course was completed	Trigonometry	Pre-Calculus	Biology	At least one International Baccalaureate class	At least two years of math beyond Algebra I
6
7
8
9
10
11
12
First Year IHE
Total

3. Educational Progress by Current GEAR UP Students: Please complete the table below indicating educational progress of current GEAR UP students. Where available, use standardized test scores to determine whether a student is performing at or above grade level. New grantees in their first year of implementation should not complete the two columns on performance. Enter the numbers in the row that coincides with the grade the students are in during the current school year. (e.g. If you served sixth grade during the first year of the grant and a standardized test was administered the first year to that sixth grade, please report on results of that standardized test when submitting the APR in the second year placing the information in the row for 7^th grade since those students would be seventh graders in the second year.)

Current Grade	Number of Students Performing at or above Grade Level in English/Language Arts	Number of Students Performing at or above Grade Level in Mathematics	Number of Students Promoted to the Next Grade Level at the End of the Prior School Year	Number of Students with 5 or More Unexcused Absences During the First 2 Quarters of the School Year	Number of Students Taking the PSAT or PLAN by end of 10th Grade	Number of Students Taking ACT or SAT Exam by the end of 11th Grade
6
7
8
9
10
11
12
Total

4. Baseline High School Graduation and College Enrollment Data: This table will be completed once at the time the students of the first cohort are 11^th graders.

For each target high school, give the number of 12^th graders, the number graduating with a high school diploma, and the number enrolled in post-secondary institutions (enrollment in less than 2 year,

2 year, and 4 year institutions) for the previous two years (e.g. if your first cohort are 11^th graders in the current school year (2009-2010), then you would complete this table using figures from the 2007-2008 and 2008-2009 school years).

* 12^th graders are those students who have the credits required to be considered a 12^th grader / senior.

Example

High School	School year	Number of 12th grade students	Number who graduated	Number enrolled in post secondary institution
Madison H.S	2007-2008	1050	955	750
Madison H.S	2008-2009	950	802	670
Fulton H.S.	2007-2008	750	500	125
Fulton H.S.	2008-20069	807	567	145

Graduation rate and enrollment rates will be calculated.

Graduation rate

79.4%

Enrollment rate

47.6%

Rows can be added to the table.

High School	School year	Number of 12th grade students	Number who graduated	Number enrolled in post secondary institution

Graduation rate and enrollment rates will be calculated.

Graduation rate

Enrollment rate

SECTION VI: SURVEY DATA

In order to complete the APR, you will need to administer surveys to GEAR UP students and parents at least every two years. Separate surveys should be provided to GEAR UP students and parents. Each survey must include certain mandatory questions. Mandatory questions for the student survey are listed in Appendix A. Mandatory questions for the parent survey are listed in Appendix B. If desired, you may translate these questions into other languages. If you would like to add additional questions to the surveys for your internal purposes, you may do so. If you are in the first award period of your grant and you have not yet conducted student and parent surveys, you may respond “N/A” to the questions in this section. Please aim to give a copy of the survey to each student and one of his/her parents

1. A. Survey Administration: In the following box, please describe how your student and parent surveys are administered. When are the surveys distributed and how (e.g., are the surveys distributed in the classroom, at GEAR UP events, through the mail, or during home visits)?

Describe the Administration of Your Surveys

2. Adequate response rates for the surveys have been set at 50% for the parent survey, and 80% for student survey. Please list the response rates for your parent and student surveys.

Parent Response Rate

____ %

Student Response Rate

____ %

If your response rates for the parent and/or student surveys are lower than the percentages given, please answer the following:

Explain why the target survey response rate(s) was not met.

What steps will you take to ensure that rates will increase the next time the survey(s) is administered?

2. Student Survey Results: Please complete the following tables indicating the results of your student survey.

A. Grade Level of Survey Respondents: Please complete the following table indicating the number of GEAR UP students at each grade level who were given and responded to the survey.

Grade Level	Number of students given the survey	Number of students who responded to the survey
6
7
8
9
10
11
12
Other
Total

B. Number of Students who have spoken with someone about College Entrance Requirements and Financial Aid: Please complete the following table indicating student response to survey questions 2 and 3 in Appendix A (Surveys).

Grade level	Number of students who have spoken with someone about college entrance requirements. (Students who responded positively to question No. 2 from Appendix A.)	Number of students who have not spoken with someone about college entrance requirements. (Students who responded negatively to question No. 2 from Appendix A.)	Number of students who have spoken with someone about the availability of financial aid. (Students who responded positively to question No. 3 from Appendix A.)	Number of students who have not spoken with someone about the availability of financial aid. (Students who responded negatively to question No. 3 from Appendix A.)
6
7
8
9
10
11
12
Other
Total

C. Perceptions of Affordability: Please complete the following table indicating student response to question #6 from Appendix A, “Do you think that you could afford to attend a public 4-year college using financial aid, scholarships, and your family’s resources?”

Response	Number of Students Responding
Definitely
Probably
Not sure
Probably not
Definitely not

3. Parent Survey Results: Please complete the following tables indicating the results of your parent survey.

1. Number of Parents who were given and completed the Survey: Please complete the following table indicating the number of parents who were given and responded to the survey.

Number of Parents Given Survey	Number of Parents Who Completed Survey

B. Number of Parents who have spoken with someone about College Entrance

Requirements and Financial Aid: Please complete the following table indicating

parent response to survey questions 1 - 3 from Appendix B.

Response	Total Number of Parents Responding
Question 1A, Yes (have spoken with someone about college entrance requirements)
Question 1B, No (have not spoken with someone about college entrance requirements)
Question 2A, Yes (have spoken with someone about financial aid)
Question 2B, No (have not spoken with someone about financial aid)

C. Number of Parents who have spoken with their children about College:

Please complete the following table indicating parent response to survey question

#4 from Appendix B, “Have you talked with your child about attending college?”

Response	Total Number of Parents Responding
Yes
No

D. Educational Expectations: Please complete the following table indicating parent responses to survey question #5 in Appendix B, “What is the highest level

of education that you think your child will achieve?”

Response	Total Number of Parents Responding
High school or less
Some college, but less than a 4-year college degree
4-year college degree or higher

E. Perceptions of Affordability: Please complete the following table indicating parent

response to question #6 from Appendix B, “Do you think that your child could

afford to attend a public 4-year college using financial aid, scholarships, and family

resources?”

Response	Number of Parents Responding
Definitely
Probably
Not sure
Probably not
Definitely not

APPENDIX A

The student survey must contain the following questions:

1. What is your current grade level?

   1. Grade 6

   2. Grade 7

   3. Grade 8

   4. Grade 9

   5. Grade 10

   6. Grade 11

   7. Grade 12

   8. Other

2. Has anyone from your school or GEAR UP ever spoken with you about college entrance requirements?

   1. Yes

   2. No

3. Has anyone from your school or GEAR UP ever spoken with you about the availability of financial aid to help you pay for college?

   1. Yes

   2. No

4. Are you knowledgeable about financial aid and the cost and benefits to you of going to college

(YES)_______________

(NO) _______________

5. What is the highest level of education that you expect to obtain?

1. High school or less

2. Some college but less than a 4-year college degree

3. 4-year college degree or higher

6. Do you think that you could afford to attend a public 4-year college using financial aid,

scholarships, and your family’s resources?

(YES)_______________

(NO) _______________

APPENDIX B

The parent survey must contain the following questions:

1. Has anyone from your child’s school or GEAR UP ever spoken with you about college entrance requirements?

   1. Yes

   2. No

2. Has anyone from your child’s school or GEAR UP ever spoken with you about the availability of financial aid to help you pay for college?

   1. Yes

   2. No

3. Are you knowledgeable about financial aid and the cost and benefits of your child pursuing postsecondary

(YES)_______________

(NO) _______________

4. Have you talked with your child about attending college?

   1. Yes

   2. No

5. What is the highest level of education that you think your child will achieve?

   1. High school or less

   2. Some college but less than a 4-year college degree

c. 4-year college degree or higher

6. Do you think that your child could afford to attend a public 4-year college using financial aid, scholarships, and your family’s resources?

(YES)_______________

(NO) _______________

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