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2008-2009 Mini-Grant Application

No Child Left Behind Act of 2001 - Title IV, 21

Century Schools, Part A

Safe and Drug Free Schools and Community

APPLICATION MUST BE TYPED AND SIGNED BY THE

APPLICANT AND PRINCIPAL

Please submit application to: Leslie Clemensen, Safe & Drug Free Grant Coordinator

620 Wilcox St. Castle Rock, CO 80104

PHONE: 303 387-0087

DEADLINE: September 26, 2008 4:00 pm

Applicant name and position/title:_____________________________________________________________

School/group:__________________________________Work phone:________________________________

Project title:______________________________________________________________________________

Signature of applicant:___________________________________________Date:______________________

Signature of principal:___________________________________________Date:_______________________

____(initial) The RtI team or/student support team is aware of this project.

____(initial) I understand I have to submit a program evaluation by March 20

, 2009

This project is related to (circle one):

PBS Olweus Second Step ART Say It Straight Victims, Aggressors & Bystanders

Other:

Description of project:_______________________________________________________________________

_________________________________________________________________________________________

How does your project support the Responsible Cititzens End Statement?______________________________

________________________________________________________________________________________

What Development Assets are you building?_____________________________________________________

________________________________________________________________________________________

How did you use the results of your needs assessment to create this project?_____________________________

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_________________________________________________________________________________________

What data was used to determine need (use percentages and numbers and source used):____________________

What outcomes do you desire?________________________________________________________________

What objectives do you have for parents and how will you include them?_______________________________

What research based educational and prevention strategies will you use?_______________________________

What strategies will be used to engage students?___________________________________________________

Who is your target population?________________________________________________________________

How many students are being served by the grant?__________

How will you collaborate with others?__________________________________________________________

How will you evaluate the effectiveness of your project?____________________________________________

Project Budget

Total amount for the project ___________

Matching funds (if applicable) ___________

Source of matching funds ___________

Itemized expenditures ––––––––––