59
Introduction and Lead Agency Program Information NYS 21st CCLC Mid-Year Report: February 2020 1. Project Number (last four digits) and Lead Agency Name: * 2. Name of Program Director/Manager completing Report: * 3. The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report, how the information provided will be collected and used by the NYSED, how to complete and submit the Report, and who to contact for technical assistance. * I acknowledge I have read the Mid-Year Program Report Information (READ FIRST) document. 4. Phone Number including area code (xxx-xxx-xxxx): * 5. Email Address: * 6. Select the type of applicant that best describes you. * NYCDOE CSD sub-grantee NYC Community Based Organization (CBO) sub-grantee Rest of State (RoS) district sub-grantee RoS CBO sub-grantee For-Profit agency (in NYC) sub-grantee For-Profit agency (in RoS) sub-grantee 7. What is your total target enrollment as indicated in your grant application ? * 8. What is your current total enrollment ( not required to meet the 30 hour minimum at this reporting time but will be required in end of year reporting)? * 1

NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

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Page 1: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

Introduction and Lead Agency Program Information

NYS 21st CCLC Mid-Year Report: February 2020

1. Project Number (last four digits) and Lead Agency Name:*

2. Name of Program Director/Manager completing Report:*

3. The Mid Year Program Report Information (READ FIRST) document contains an explanation of thepurposes of this Report, how the information provided will be collected and used by the NYSED, how tocomplete and submit the Report, and who to contact for technical assistance.

*

I acknowledge I have read the Mid-Year Program Report Information (READ FIRST) document.

4. Phone Number including area code (xxx-xxx-xxxx):*

5. Email Address:*

6. Select the type of applicant that best describes you.*

NYCDOE CSD sub-grantee

NYC Community Based Organization (CBO) sub-grantee

Rest of State (RoS) district sub-grantee

RoS CBO sub-grantee

For-Profit agency (in NYC) sub-grantee

For-Profit agency (in RoS) sub-grantee

7. What is your total target enrollment as indicated in your grant application?*

8. What is your current total enrollment (not required to meet the 30 hour minimum at this reporting time butwill be required in end of year reporting)?

*

1

Page 2: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

9. Mid-year attendance reporting will not be used to determine budget adjustments. Sub-grantees will furnishthe NYSED with a roster of participants served in its program and the hours of participation for eachparticipant as of June 30th in each program year in a format to be provided by the NYSED Program Office.This roster is due by July 15th. For the purposes of this RFP, students must attend the program for a minimumof 30 hours in the program year to be considered a participant. For Non-Profit sub-grantees, in grant yearstwo through five, if less than 95% of the student participation target set forth in the 2017-2018 application’sParticipating Schools Form and reflected in the Composite Budget has met the minimum threshold of at least30 hours, the sub-grantee's budget will be proportionately reduced by the amount of the percentagedeficiency. There will be no penalties the first year for Non-Profits. For For-Profit sub-grantees, in grant yearsone through five, if less than 95% of the student participation target set forth in the 2017-2018 application’sParticipating Schools Form and reflected in the Composite Budget has met the minimum threshold of at least30 hours per participant, the sub-grantee's budget will be proportionately reduced by the amount of thepercentage deficiency.

*

I have read and understand all of the above requirements about attendance reporting and possible budget adjustments.

10. Number of program sites in this grant:*

1

2

3

4

5

6

7

8

9

10

11. Has there been turnover in any key staff positions since this time last year?*

Yes

No

2

Page 3: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

I. Lead Agency Applicant Information (continued)

NYS 21st CCLC Mid-Year Report: February 2020

Other (please indicate title/role)

12. If you had turnover in key staff positions, please indicate staff changes below. Check all that apply.

Program Director/Program Manager

Site Coordinator

Fiscal Manager

CBO Executive/Executive Management

School Administrator (Principal, Charter School Leader, etc.)

3

Page 4: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

A sub-grantee needs to keep track of the expenditures as well as payments received. The sub-granteeneeds to keep on top of the balance remaining in each budget category. If the balance gets low or maybe exceeded, a budget amendment will be required. Both the fiscal and program staff need to worktogether in budget oversight and ensure appropriate documentation of fiscal meetings [ComplianceIndicators C-1-C-10, SMV Report]

II. Fiscal Information

NYS 21st CCLC Mid-Year Report: February 2020

13. Annual grant award amount:

Please enter a whole number rounded to the nearest dollar. Do not use commas, periods, or dollar signs.

*

14. Expenditures to-date:

Please enter a whole number rounded to the nearest dollar. Do not use commas, periods, or dollar signs.

*

15. Payments received from the NYSED this program year:

Please enter a whole number rounded to the nearest dollar. Do not use commas, periods, or dollar signs.

*

16. How often is the budget jointly reviewed by program and fiscal offices?*

Weekly

Monthly

Quarterly

Other (please specify)

17. Fiscal Point of Contact:*

18. Email Address:*

4

Page 5: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

Local Evaluation is an important element of the grant. It is the Program Director/Manager'sresponsibility to make sure he/she is acquainted with the specific requirements entailed andcooperate with the evaluator to ensure that all evaluation activities are being completed andappropriately documented [Compliance Indicators Section H-1-H-8, SMV Report].

Evaluation Information, Communication of Evaluation Findings &Data Driven ProgramImprovement

NYS 21st CCLC Mid-Year Report: February 2020

If yes, please indicate date.

19. Have you changed evaluators since the last year's reporting?*

Yes

No

20. Name of (current) Independent Evaluator:*

21. Email address:*

22. What is your annual budget for evaluation? Please enter a whole number rounded to the nearest dollar. Do not use commas, periods, or dollar signs.

*

23. On average, how frequently have you and your independent evaluator maintainedcontact? Communication must be documented [Compliance Indicators H-3(b) and H-3(c), SMV Report]

*

Daily

Weekly

Monthly

Quarterly

Other (please specify):

5

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N/A

Once so farthis year

About onceper quarter

About once amonth

About everytwo weeks Weekly As needed

Interim EvaluationReports

Memoranda

Periodic briefing reports

Advisory GroupMeetings

Other meetings

Email communications

Phone communications

Other (specify below)

Other communication method

24. Programs have the responsibility of communicating local evaluation findings- i.e. informationabout program implementation and impact- to all vital stakeholder groups within the program and inthe community. They must also retain documentation to evidence this communication [ComplianceIndicator H-7, SMV Report]

Use the table below to indicate how frequently your program team has undertaken each of the followingmethods, processes, or products, so far this year, to communicate formative and summative evaluationfindings to program stakeholders. For any communication strategies that your team has not used this year,check "N/A".

*

6

Page 7: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

ProgramDirector/Manager

SiteCoordinator

CommunitySchoolDirector

FrontLineStaff

Principal/CharterSchool Leader Evaluator

CBOpartner(s)

Communitymembers Students Parents

AnnualEvaluationReports

InterimEvaluationReports

Memoranda

Periodic briefingreports

Advisory GroupMeetings

Other meetings

Emailcommunications

Phonecommunications

Othercommunicationstrategy (specifybelow)

Other communication strategy

25. Use the table below to indicate which stakeholders have received communications of local evaluationfindings so far this year. Select stakeholders who received this information for each communicationmethod. Check all that apply for each strategy .

*

7

Page 8: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

26. Programs also have the responsibility of using implementation (formative) and outcome(summative) evaluation findings to inform continuous, data-based program improvement. Suchfindings and related recommendations must be included in their Annual Evaluation Reports (AERs),but may also be sourced from other activities such as monitoring visits, advisory group meetingsand/or the QSA process. Programs must retain documentation of action plans and/or other evidenceof improvement activities informed by these recommendations [Compliance Indicator H-5, SMVReport].

Use the list below to indicate what form(s) of evidence you have maintained about improvement activitiesconducted so far this year in response to recommendations from the prior year’s AER, as well as othersources of recommendations. Check all that apply. In the next question you will be asked to upload oneexample from each source that you checked.

*

Action plans

Notes/Minutes from Advisory Council and/other meetings, including online meetings and/or conference calls

Correspondence among various program staff, school staff, local evaluator and/or community partners

Other evidence of improvement activities informed by data-based recommendations (please describe):

No file chosen

27. With reference to the previous question, please upload one example of each of the following documentsthat were checked above:(A) A recent Action Plan(B) One example of notes/minutes that reflects specific plans to respond to data-based programimprovements(C) One example of correspondence that reflects specific plans to respond to data-based programimprovements

*

Choose File

28. Your local evaluator is required to conduct two in-person visits to each program site, per program year-one in the fall, one in the spring [Compliance Indicator H-1(c), SMV Report]. Which of the following visits haveoccurred at each of your program sites? Check all that apply.

*

Fall Site Visits at ALL program sites

Fall Site Visits at SOME, but not all program sites

Spring Site Visits at ALL program sites

Spring Site Visits at SOME, but not all program sites

No Site Visits have been conducted

29. Please list the date(s) of each COMPLETED site visit(s) conducted by your local evaluator. (If no site visitshave been completed this year, write "N/A").

*

8

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30. Please list the date(s) of any PENDING/PLANNED on-site visit(s) your local evaluator is scheduled toconduct, if applicable. (If all on-site visits have already been completed this year, OR, if no visits have beenplanned, write "N/A").

*

If there is no documentation for either of these visits, please provide explanation.

31. Documentation of these required on-site visits is required [Compliance Indicator H-1(c), SMV Report] andcould consist of a copy of the site visit protocol with notes completed by the evaluator, a memo or summaryreport of site visit submitted by the evaluator, or other evidence of a completed on-site visit. Whatdocumentation does the site have for these on-site visits from prior years as well as this year?

*

Documentation for this fall's on-site visits only

Documentation for last spring's on-site visits only

Documentation for BOTH on-site visits

No documentation

9

Page 10: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

The following questions ask for general information for each program site such as daily operationtimes, current and target enrollment, and activities. Please fill out a separate page for each programsite.

IV. Program Site Information: Program Site 1

NYS 21st CCLC Mid-Year Report: February 2020

32. Name of Program Site:*

33. Physical Address of Program Site

34. Indicate Program Operation hours. Check all that apply.*

Summer

Before School

During School (for approved ELT programs only)

After School

Weekends

During School Closings (i.e. holidays and or vacations)

Program start date(MM/DD/YYYY):

Grade Level(s) served:

Days and Hours ofOperation (ex. M, W, F2:30-5:30):

Target Enrollment for thissite (as stated in proposal):

Current Enrollment at thisProgram Site:

Average Daily ProgramAttendance at this Site:

35. Program Site Information:*

36. Is School-Aged Child Care (SACC) Registration required for this program site?*

Yes

No

10

Page 11: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

No file chosen

37. If a SACC Registration is required, please upload the most current copy of the School Age Child Care(SACC) Registration. Please save the file name with your Project Number and name of site.

Choose File

If yes, please briefly discuss benefits and challenges.

38. Is ELT offered at this site?*

Yes

No

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

39. Core Activities are those explicitly defined in your Template for Goals and Objectives and (updated)Program Logic Model. They are the major activities designed to meet the student outcome objectives youidentified in your grant for, both, helping students improve their academic achievement (Core EducationalServices/Academic Support), and helping students develop skills through enrichment activities (Enrichmentand Youth Development Services) [Compliance Indicator E-2, SMV Report]. Core Activities currently beingprovided at each program site need to demonstrate alignment with the Template for Goals and Objectives,as it appears in proposal, and/or including any NYSED-approved program modifications [Compliance IndicatorE-3, SMV Report].

List the Core Activities aligned to each of the NYS 21st CCLC Objectives that are currently being provided forSub-Objective 1.1 Core Educational Services/Academic Support to improve student academic outcomesat this site. For each academic enrichment activity, also indicate whether or not it has changed from youroriginal grant application; i.e. (1) remained unchanged from original activity described in the grant application,(2) if it has been changed via an approved program modification, or (3) if it has been requested to be changedvia a program modification request submitted to the NYSED which is still pending.

*

11

Page 12: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

40. List the Core Activities aligned to each of the NYS 21st CCLC Objectives that are currently being providedfor Sub-Objective 1.2 Enrichment and Youth Development to improve student behavioral and affectiveoutcomes at this site. For each enrichment activity, also indicate whether it has changed from your originalgrant application; i.e. (1) remained unchanged from original activity described in the grant application, (2) if ithas been changed via an approved program modification, or (3) if it has been requested to be changed via aprogram modification request submitted to the NYSED which is still pending.

*

41. Have you completed entering information for all of your program sites?*

Yes

No

Choosing Yes will move you to the next section of the Mid-Year Report. Choosing No will move you to a new Program Site Informationform where you can enter data for an additional site. Choose No if you still have additional program sites to report.

12

Page 13: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

The following questions ask for general information for each program site such as daily operationtimes, current and target enrollment, and activities. Please fill out a separate page for each programsite.

IV. Program Site Information: Program Site 2

NYS 21st CCLC Mid-Year Report: February 2020

42. Name of Program Site:*

43. Physical Address of Program Site

44. Indicate Program Operation hours. Check all that apply.*

Summer

Before School

During School (for approved ELT programs only)

After School

Weekends

During School Closings (i.e. holidays and or vacations)

Program start date(MM/DD/YYYY):

Grade Level(s) served:

Days and Hours ofOperation (ex. M, W, F2:30-5:30):

Target Enrollment for thissite (as stated in proposal):

Current Enrollment at thisProgram Site:

Average Daily ProgramAttendance at this Site:

45. Program Site Information:*

46. Is School-Aged Child Care (SACC) Registration required for this program site?*

Yes

No

13

Page 14: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

No file chosen

47. If a SACC Registration is required, please upload the most current copy of the School Age Child Care(SACC) Registration. Please save the file name with your Project Number and name of site.

Choose File

If yes, please briefly discuss benefits and challenges.

48. Is ELT offered at this site?*

Yes

No

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

49. Core Activities are those explicitly defined in your Template for Goals and Objectives and (updated)Program Logic Model. They are the major activities designed to meet the student outcome objectives youidentified in your grant for, both, helping students improve their academic achievement (Core EducationalServices/Academic Support), and helping students develop skills through enrichment activities (Enrichmentand Youth Development Services) [Compliance Indicator E-2, SMV Report]. Core Activities currently beingprovided at each program site need to demonstrate alignment with the Template for Goals and Objectives,as it appears in proposal, and/or including any NYSED-approved program modifications [Compliance IndicatorE-3, SMV Report].

List the Core Activities aligned to each of the NYS 21st CCLC Objectives that are currently being provided forSub-Objective 1.1 Core Educational Services/Academic Support to improve student academic outcomesat this site. For each academic enrichment activity, also indicate whether or not it has changed from youroriginal grant application; i.e. (1) remained unchanged from original activity described in the grant application,(2) if it has been changed via an approved program modification, or (3) if it has been requested to be changedvia a program modification request submitted to the NYSED which is still pending.

*

14

Page 15: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

50. List the Core Activities aligned to each of the NYS 21CCLC Objectives that are currently being provided forSub-Objective 1.2 Enrichment and Youth Development to improve student behavioral and affectiveoutcomes at this site. For each enrichment activity, also indicate whether it has changed from your originalgrant application; i.e. (1) remained unchanged from original activity described in the grant application, (2) if ithas been changed via an approved program modification, or (3) if it has been requested to be changed via aprogram modification request submitted to the NYSED which is still pending.

*

51. Have you completed entering information for all of your program sites?*

Yes

No

Choosing Yes will move you to the next section of the Mid-Year Report. Choosing No will move you to a new Program Site Informationform where you can enter data for an additional site. Choose No if you still have additional program sites to report.

15

Page 16: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

The following questions ask for general information for each program site such as daily operationtimes, current and target enrollment, and activities. Please fill out a separate page for each programsite.

IV. Program Site Information: Program Site 3

NYS 21st CCLC Mid-Year Report: February 2020

52. Name of Program Site:*

53. Physical Address of Program Site

54. Indicate Program Operation hours. Check all that apply.*

Summer

Before School

During School (for approved ELT programs only)

After School

Weekends

During School Closings (i.e. holidays and or vacations)

Program start date(MM/DD/YYYY):

Grade Level(s) served:

Days and Hours ofOperation (ex. M, W, F2:30-5:30):

Target Enrollment for thissite (as stated in proposal):

Current Enrollment at thisProgram Site:

Average Daily ProgramAttendance at this Site:

55. Program Site Information:*

56. Is School-Aged Child Care (SACC) Registration required for this program site?*

Yes

No

16

Page 17: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

No file chosen

57. If a SACC Registration is required, please upload the most current copy of the School Age Child Care(SACC) Registration. Please save the file name with your Project Number and name of site.

Choose File

If yes, please briefly discuss benefits and challenges.

58. Is ELT offered at this site?*

Yes

No

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

59. Core Activities are those explicitly defined in your Template for Goals and Objectives and (updated)Program Logic Model. They are the major activities designed to meet the student outcome objectives youidentified in your grant for, both, helping students improve their academic achievement (Core EducationalServices/Academic Support), and helping students develop skills through enrichment activities (Enrichmentand Youth Development Services) [Compliance Indicator E-2, SMV Report]. Core Activities currently beingprovided at each program site need to demonstrate alignment with the Template for Goals and Objectives,as it appears in proposal, and/or including any NYSED-approved program modifications [Compliance IndicatorE-3, SMV Report].

List the Core Activities aligned to each of the NYS 21st CCLC Objectives that are currently being provided forSub-Objective 1.1 Core Educational Services/Academic Support to improve student academic outcomesat this site. For each academic enrichment activity, also indicate whether or not it has changed from youroriginal grant application; i.e. (1) remained unchanged from original activity described in the grant application,(2) if it has been changed via an approved program modification, or (3) if it has been requested to be changedvia a program modification request submitted to the NYSED which is still pending.

*

17

Page 18: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

60. List the Core Activities aligned to each of the NYS 21CCLC Objectives that are currently being provided forSub-Objective 1.2 Enrichment and Youth Development to improve student behavioral and affectiveoutcomes at this site. For each enrichment activity, also indicate whether it has changed from your originalgrant application; i.e. (1) remained unchanged from original activity described in the grant application, (2) if ithas been changed via an approved program modification, or (3) if it has been requested to be changed via aprogram modification request submitted to the NYSED which is still pending.

*

61. Have you completed entering information for all of your program sites?*

Yes

No

Choosing Yes will move you to the next section of the Mid-Year Report. Choosing No will move you to a new Program Site Informationform where you can enter data for an additional site. Choose No if you still have additional program sites to report.

18

Page 19: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

The following questions ask for general information for each program site such as daily operationtimes, current and target enrollment, and activities. Please fill out a separate page for each programsite.

IV. Program Site Information: Program Site 4

NYS 21st CCLC Mid-Year Report: February 2020

62. Name of Program Site:*

63. Physical Address of Program Site

64. Indicate Program Operation hours. Check all that apply.*

Summer

Before School

During School (for approved ELT programs only)

After School

Weekends

During School Closings (i.e. holidays and or vacations)

Program start date(MM/DD/YYYY):

Grade Level(s) served:

Days and Hours ofOperation (ex. M, W, F2:30-5:30):

Target Enrollment for thissite (as stated in proposal):

Current Enrollment at thisProgram Site:

Average Daily ProgramAttendance at this Site:

65. Program Site Information:*

66. Is School-Aged Child Care (SACC) Registration required for this program site?*

Yes

No

19

Page 20: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

No file chosen

67. If a SACC Registration is required, please upload the most current copy of the School Age Child Care(SACC) Registration. Please save the file name with your Project Number and name of site.

Choose File

If yes, please briefly discuss benefits and challenges.

68. Is ELT offered at this site?*

Yes

No

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

69. Core Activities are those explicitly defined in your Template for Goals and Objectives and (updated)Program Logic Model. They are the major activities designed to meet the student outcome objectives youidentified in your grant for, both, helping students improve their academic achievement (Core EducationalServices/Academic Support), and helping students develop skills through enrichment activities (Enrichmentand Youth Development Services) [Compliance Indicator E-2, SMV Report]. Core Activities currently beingprovided at each program site need to demonstrate alignment with the Template for Goals and Objectives,as it appears in proposal, and/or including any NYSED-approved program modifications [Compliance IndicatorE-3, SMV Report].

List the Core Activities aligned to each of the NYS 21st CCLC Objectives that are currently being provided forSub-Objective 1.1 Core Educational Services/Academic Support to improve student academic outcomesat this site. For each academic enrichment activity, also indicate whether or not it has changed from youroriginal grant application; i.e. (1) remained unchanged from original activity described in the grant application,(2) if it has been changed via an approved program modification, or (3) if it has been requested to be changedvia a program modification request submitted to the NYSED which is still pending.

*

20

Page 21: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

70. List the Core Activities aligned to each of the NYS 21CCLC Objectives that are currently being provided forSub-Objective 1.2 Enrichment and Youth Development to improve student behavioral and affectiveoutcomes at this site. For each enrichment activity, also indicate whether it has changed from your originalgrant application; i.e. (1) remained unchanged from original activity described in the grant application, (2) if ithas been changed via an approved program modification, or (3) if it has been requested to be changed via aprogram modification request submitted to the NYSED which is still pending.

*

71. Have you completed entering information for all of your program sites?*

Yes

No

Choosing Yes will move you to the next section of the Mid-Year Report. Choosing No will move you to a new Program Site Informationform where you can enter data for an additional site. Choose No if you still have additional program sites to report.

21

Page 22: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

The following questions ask for general information for each program site such as daily operationtimes, current and target enrollment, and activities. Please fill out a separate page for each programsite.

IV. Program Site Information: Program Site 5

NYS 21st CCLC Mid-Year Report: February 2020

72. Name of Program Site:*

73. Physical Address of Program Site

74. Indicate Program Operation hours. Check all that apply.*

Summer

Before School

During School (for approved ELT programs only)

After School

Weekends

During School Closings (i.e. holidays and or vacations)

Program start date(MM/DD/YYYY):

Grade Level(s) served:

Days and Hours ofOperation (ex. M, W, F2:30-5:30):

Target Enrollment for thissite (as stated in proposal):

Current Enrollment at thisProgram Site:

Average Daily ProgramAttendance at this Site:

75. Program Site Information:*

76. Is School-Aged Child Care (SACC) Registration required for this program site?*

Yes

No

22

Page 23: NYS 21st CCLC Mid-Year Report: February 2020 Introduction ... · The Mid Year Program Report Information (READ FIRST) document contains an explanation of the purposes of this Report,

No file chosen

77. If a SACC Registration is required, please upload the most current copy of the School Age Child Care(SACC) Registration. Please save the file name with your Project Number and name of site.

Choose File

If yes, please briefly discuss benefits and challenges.

78. Is ELT offered at this site?*

Yes

No

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

79. Core Activities are those explicitly defined in your Template for Goals and Objectives and (updated)Program Logic Model. They are the major activities designed to meet the student outcome objectives youidentified in your grant for, both, helping students improve their academic achievement (Core EducationalServices/Academic Support), and helping students develop skills through enrichment activities (Enrichmentand Youth Development Services) [Compliance Indicator E-2, SMV Report]. Core Activities currently beingprovided at each program site need to demonstrate alignment with the Template for Goals and Objectives,as it appears in proposal, and/or including any NYSED-approved program modifications [Compliance IndicatorE-3, SMV Report].

List the Core Activities aligned to each of the NYS 21st CCLC Objectives that are currently being provided forSub-Objective 1.1 Core Educational Services/Academic Support to improve student academic outcomesat this site. For each academic enrichment activity, also indicate whether or not it has changed from youroriginal grant application; i.e. (1) remained unchanged from original activity described in the grant application,(2) if it has been changed via an approved program modification, or (3) if it has been requested to be changedvia a program modification request submitted to the NYSED which is still pending.

*

23

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Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

80. List the Core Activities aligned to each of the NYS 21CCLC Objectives that are currently being provided forSub-Objective 1.2 Enrichment and Youth Development to improve student behavioral and affectiveoutcomes at this site. For each enrichment activity, also indicate whether it has changed from your originalgrant application; i.e. (1) remained unchanged from original activity described in the grant application, (2) if ithas been changed via an approved program modification, or (3) if it has been requested to be changed via aprogram modification request submitted to the NYSED which is still pending.

*

81. Have you completed entering information for all of your program sites?*

Yes

No

Choosing Yes will move you to the next section of the Mid-Year Report. Choosing No will move you to a new Program Site Informationform where you can enter data for an additional site. Choose No if you still have additional program sites to report.

24

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The following questions ask for general information for each program site such as daily operationtimes, current and target enrollment, and activities. Please fill out a separate page for each programsite.

IV. Program Site Information: Program Site 6

NYS 21st CCLC Mid-Year Report: February 2020

82. Name of Program Site:*

83. Physical Address of Program Site

84. Indicate Program Operation hours. Check all that apply.*

Summer

Before School

During School (for approved ELT programs only)

After School

Weekends

During School Closings (i.e. holidays and or vacations)

Program start date(MM/DD/YYYY):

Grade Level(s) served:

Days and Hours ofOperation (ex. M, W, F2:30-5:30):

Target Enrollment for thissite (as stated in proposal):

Current Enrollment at thisProgram Site:

Average Daily ProgramAttendance at this Site:

85. Program Site Information:*

86. Is School-Aged Child Care (SACC) Registration required for this program site?*

Yes

No

25

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No file chosen

87. If a SACC Registration is required, please upload the most current copy of the School Age Child Care(SACC) Registration. Please save the file name with your Project Number and name of site.

Choose File

If yes, please briefly discuss benefits and challenges.

88. Is ELT offered at this site?*

Yes

No

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

89. Core Activities are those explicitly defined in your Template for Goals and Objectives and (updated)Program Logic Model. They are the major activities designed to meet the student outcome objectives youidentified in your grant for, both, helping students improve their academic achievement (Core EducationalServices/Academic Support), and helping students develop skills through enrichment activities (Enrichmentand Youth Development Services) [Compliance Indicator E-2, SMV Report]. Core Activities currently beingprovided at each program site need to demonstrate alignment with the Template for Goals and Objectives,as it appears in proposal, and/or including any NYSED-approved program modifications [Compliance IndicatorE-3, SMV Report].

List the Core Activities aligned to each of the NYS 21st CCLC Objectives that are currently being provided forSub-Objective 1.1 Core Educational Services/Academic Support to improve student academic outcomesat this site. For each academic enrichment activity, also indicate whether or not it has changed from youroriginal grant application; i.e. (1) remained unchanged from original activity described in the grant application,(2) if it has been changed via an approved program modification, or (3) if it has been requested to be changedvia a program modification request submitted to the NYSED which is still pending.

*

26

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Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

90. List the Core Activities aligned to each of the NYS 21CCLC Objectives that are currently being provided forSub-Objective 1.2 Enrichment and Youth Development to improve student behavioral and affectiveoutcomes at this site. For each enrichment activity, also indicate whether it has changed from your originalgrant application; i.e. (1) remained unchanged from original activity described in the grant application, (2) if ithas been changed via an approved program modification, or (3) if it has been requested to be changed via aprogram modification request submitted to the NYSED which is still pending.

*

91. Have you completed entering information for all of your program sites?*

Yes

No

Choosing Yes will move you to the next section of the Mid-Year Report. Choosing No will move you to a new Program Site Informationform where you can enter data for an additional site. Choose No if you still have additional program sites to report.

27

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The following questions ask for general information for each program site such as daily operationtimes, current and target enrollment, and activities. Please fill out a separate page for each programsite.

IV. Program Site Information: Program Site 7

NYS 21st CCLC Mid-Year Report: February 2020

92. Name of Program Site:*

93. Physical Address of Program Site

94. Indicate Program Operation hours. Check all that apply.*

Summer

Before School

During School (for approved ELT programs only)

After School

Weekends

During School Closings (i.e. holidays and or vacations)

Program start date(MM/DD/YYYY):

Grade Level(s) served:

Days and Hours ofOperation (ex. M, W, F2:30-5:30):

Target Enrollment for thissite (as stated in proposal):

Current Enrollment at thisProgram Site:

Average Daily ProgramAttendance at this Site:

95. Program Site Information:*

96. Is School-Aged Child Care (SACC) Registration required for this program site?*

Yes

No

28

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No file chosen

97. If a SACC Registration is required, please upload the most current copy of the School Age Child Care(SACC) Registration. Please save the file name with your Project Number and name of site.

Choose File

If yes, please briefly discuss benefits and challenges.

98. Is ELT offered at this site?*

Yes

No

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

99. Core Activities are those explicitly defined in your Template for Goals and Objectives and (updated)Program Logic Model. They are the major activities designed to meet the student outcome objectives youidentified in your grant for, both, helping students improve their academic achievement (Core EducationalServices/Academic Support), and helping students develop skills through enrichment activities (Enrichmentand Youth Development Services) [Compliance Indicator E-2, SMV Report]. Core Activities currently beingprovided at each program site need to demonstrate alignment with the Template for Goals and Objectives,as it appears in proposal, and/or including any NYSED-approved program modifications [Compliance IndicatorE-3, SMV Report].

List the Core Activities aligned to each of the NYS 21st CCLC Objectives that are currently being provided forSub-Objective 1.1 Core Educational Services/Academic Support to improve student academic outcomesat this site. For each academic enrichment activity, also indicate whether or not it has changed from youroriginal grant application; i.e. (1) remained unchanged from original activity described in the grant application,(2) if it has been changed via an approved program modification, or (3) if it has been requested to be changedvia a program modification request submitted to the NYSED which is still pending.

*

29

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Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

100. List the Core Activities aligned to each of the NYS 21CCLC Objectives that are currently being providedfor Sub-Objective 1.2 Enrichment and Youth Development to improve student behavioral and affectiveoutcomes at this site. For each enrichment activity, also indicate whether it has changed from your originalgrant application; i.e. (1) remained unchanged from original activity described in the grant application, (2) if ithas been changed via an approved program modification, or (3) if it has been requested to be changed via aprogram modification request submitted to the NYSED which is still pending.

*

101. Have you completed entering information for all of your program sites?*

Yes

No

Choosing Yes will move you to the next section of the Mid-Year Report. Choosing No will move you to a new Program Site Informationform where you can enter data for an additional site. Choose No if you still have additional program sites to report.

30

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The following questions ask for general information for each program site such as daily operationtimes, current and target enrollment, and activities. Please fill out a separate page for each programsite.

IV. Program Site Information: Program Site 8

NYS 21st CCLC Mid-Year Report: February 2020

102. Name of Program Site:*

103. Physical Address of Program Site

104. Indicate Program Operation hours. Check all that apply.*

Summer

Before School

During School (for approved ELT programs only)

After School

Weekends

During School Closings (i.e. holidays and or vacations)

Program start date(MM/DD/YYYY):

Grade Level(s) served:

Days and Hours ofOperation (ex. M, W, F2:30-5:30):

Target Enrollment for thissite (as stated in proposal):

Current Enrollment at thisProgram Site:

Average Daily ProgramAttendance at this Site:

105. Program Site Information:*

106. Is School-Aged Child Care (SACC) Registration required for this program site?*

Yes

No

31

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No file chosen

107. If a SACC Registration is required, please upload the most current copy of the School Age Child Care(SACC) Registration. Please save the file name with your Project Number and name of site.

Choose File

If yes, please briefly discuss benefits and challenges.

108. Is ELT offered at this site?*

Yes

No

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

109. Core Activities are those explicitly defined in your Template for Goals and Objectives and (updated)Program Logic Model. They are the major activities designed to meet the student outcome objectives youidentified in your grant for, both, helping students improve their academic achievement (Core EducationalServices/Academic Support), and helping students develop skills through enrichment activities (Enrichmentand Youth Development Services) [Compliance Indicator E-2, SMV Report]. Core Activities currently beingprovided at each program site need to demonstrate alignment with the Template for Goals and Objectives,as it appears in proposal, and/or including any NYSED-approved program modifications [Compliance IndicatorE-3, SMV Report].

List the Core Activities aligned to each of the NYS 21st CCLC Objectives that are currently being provided forSub-Objective 1.1 Core Educational Services/Academic Support to improve student academic outcomesat this site. For each academic enrichment activity, also indicate whether or not it has changed from youroriginal grant application; i.e. (1) remained unchanged from original activity described in the grant application,(2) if it has been changed via an approved program modification, or (3) if it has been requested to be changedvia a program modification request submitted to the NYSED which is still pending.

*

32

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Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

110. List the Core Activities aligned to each of the NYS 21CCLC Objectives that are currently being providedfor Sub-Objective 1.2 Enrichment and Youth Development to improve student behavioral and affectiveoutcomes at this site. For each enrichment activity, also indicate whether it has changed from your originalgrant application; i.e. (1) remained unchanged from original activity described in the grant application, (2) if ithas been changed via an approved program modification, or (3) if it has been requested to be changed via aprogram modification request submitted to the NYSED which is still pending.

*

111. Have you completed entering information for all of your program sites?*

Yes

No

Choosing Yes will move you to the next section of the Mid-Year Report. Choosing No will move you to a new Program Site Informationform where you can enter data for an additional site. Choose No if you still have additional program sites to report.

33

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The following questions ask for general information for each program site such as daily operationtimes, current and target enrollment, and activities. Please fill out a separate page for each programsite.

IV. Program Site Information: Program Site 9

NYS 21st CCLC Mid-Year Report: February 2020

112. Name of Program Site:*

113. Physical Address of Program Site

114. Indicate Program Operation hours. Check all that apply.*

Summer

Before School

During School (for approved ELT programs only)

After School

Weekends

During School Closings (i.e. holidays and or vacations)

Program start date(MM/DD/YYYY):

Grade Level(s) served:

Days and Hours ofOperation (ex. M, W, F2:30-5:30):

Target Enrollment for thissite (as stated in proposal):

Current Enrollment at thisProgram Site:

Average Daily ProgramAttendance at this Site:

115. Program Site Information:*

116. Is School-Aged Child Care (SACC) Registration required for this program site?*

Yes

No

34

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No file chosen

117. If a SACC Registration is required, please upload the most current copy of the School Age Child Care(SACC) Registration. Please save the file name with your Project Number and name of site.

Choose File

If yes, please briefly discuss benefits and challenges.

118. Is ELT offered at this site?*

Yes

No

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

119. Core Activities are those explicitly defined in your Template for Goals and Objectives and (updated)Program Logic Model. They are the major activities designed to meet the student outcome objectives youidentified in your grant for, both, helping students improve their academic achievement (Core EducationalServices/Academic Support), and helping students develop skills through enrichment activities (Enrichmentand Youth Development Services) [Compliance Indicator E-2, SMV Report]. Core Activities currently beingprovided at each program site need to demonstrate alignment with the Template for Goals and Objectives,as it appears in proposal, and/or including any NYSED-approved program modifications [Compliance IndicatorE-3, SMV Report].

List the Core Activities aligned to each of the NYS 21st CCLC Objectives that are currently being provided forSub-Objective 1.1 Core Educational Services/Academic Support to improve student academic outcomesat this site. For each academic enrichment activity, also indicate whether or not it has changed from youroriginal grant application; i.e. (1) remained unchanged from original activity described in the grant application,(2) if it has been changed via an approved program modification, or (3) if it has been requested to be changedvia a program modification request submitted to the NYSED which is still pending.

*

35

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Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

120. List the Core Activities aligned to each of the NYS 21CCLC Objectives that are currently being providedfor Sub-Objective 1.2 Enrichment and Youth Development to improve student behavioral and affectiveoutcomes at this site. For each enrichment activity, also indicate whether it has changed from your originalgrant application; i.e. (1) remained unchanged from original activity described in the grant application, (2) if ithas been changed via an approved program modification, or (3) if it has been requested to be changed via aprogram modification request submitted to the NYSED which is still pending.

*

121. Have you completed entering information for all of your program sites?*

Yes

No

Choosing Yes will move you to the next section of the Mid-Year Report. Choosing No will move you to a new Program Site Informationform where you can enter data for an additional site. Choose No if you still have additional program sites to report.

36

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The following questions ask for general information for each program site such as daily operationtimes, current and target enrollment, and activities. Please fill out a separate page for each programsite.

IV. Program Site Information: Program Site 10

NYS 21st CCLC Mid-Year Report: February 2020

122. Name of Program Site:*

123. Physical Address of Program Site

124. Indicate Program Operation hours. Check all that apply.*

Summer

Before School

During School (for approved ELT programs only)

After School

Weekends

During School Closings (i.e. holidays and or vacations)

Program start date(MM/DD/YYYY):

Grade Level(s) served:

Days and Hours ofOperation (ex. M, W, F2:30-5:30):

Target Enrollment for thissite (as stated in proposal):

Current Enrollment at thisProgram Site:

Average Daily ProgramAttendance at this Site:

125. Program Site Information:*

126. Is School-Aged Child Care (SACC) Registration required for this program site?*

Yes

No

37

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No file chosen

127. If a SACC Registration is required, please upload the most current copy of the School Age Child Care(SACC) Registration. Please save the file name with your Project Number and name of site.

Choose File

If yes, please briefly discuss benefits and challenges.

128. Is ELT offered at this site?*

Yes

No

Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

129. Core Activities are those explicitly defined in your Template for Goals and Objectives and (updated)Program Logic Model. They are the major activities designed to meet the student outcome objectives youidentified in your grant for, both, helping students improve their academic achievement (Core EducationalServices/Academic Support), and helping students develop skills through enrichment activities (Enrichmentand Youth Development Services) [Compliance Indicator E-2, SMV Report]. Core Activities currently beingprovided at each program site need to demonstrate alignment with the Template for Goals and Objectives,as it appears in proposal, and/or including any NYSED-approved program modifications [Compliance IndicatorE-3, SMV Report].

List the Core Activities aligned to each of the NYS 21st CCLC Objectives that are currently being provided forSub-Objective 1.1 Core Educational Services/Academic Support to improve student academic outcomesat this site. For each academic enrichment activity, also indicate whether or not it has changed from youroriginal grant application; i.e. (1) remained unchanged from original activity described in the grant application,(2) if it has been changed via an approved program modification, or (3) if it has been requested to be changedvia a program modification request submitted to the NYSED which is still pending.

*

38

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Activity 1 (specify):

Activity 2 (specify):

Activity 3 (specify):

Activity 4 (specify):

Activity 5 (specify):

Activity 6 (specify):

Activity 7 (specify):

Activity 8 (specify):

Activity 9 (specify):

Activity 10 (specify):

130. List the Core Activities aligned to each of the NYS 21CCLC Objectives that are currently being providedfor Sub-Objective 1.2 Enrichment and Youth Development to improve student behavioral and affectiveoutcomes at this site. For each enrichment activity, also indicate whether it has changed from your originalgrant application; i.e. (1) remained unchanged from original activity described in the grant application, (2) if ithas been changed via an approved program modification, or (3) if it has been requested to be changed via aprogram modification request submitted to the NYSED which is still pending.

*

39

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V(a). Professional Development InformationPrograms are required to provide targeted professional development for all program staff which isfocused on strengthening their use of effective instructional practices and their provision ofenrichment opportunities, and which engages them in the achievement of the program's studentoutcome goals [Compliance Indicator D-5, SMV Report]

V. Overall Program Information

NYS 21st CCLC Mid-Year Report: February 2020

131. Approximately how frequently is Professional Development offered to program and partner staff?*

Weekly

Monthly

Quarterly

Other (please specify):

Other (please specify):

132. Professional Development opportunities are made available to: Check all that apply.*

Front-line Staff

Support Staff

Program Adminstrative Staff

School Teachers

School Administrators

Community Partners

40

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Other (please specify):

133. Professional Development Topics covered include: Check all that apply.*

Youth Development

Mental Health Education

Social Emotional Learning

Classroom Management

Lesson Planning

NYS Learning Standards

STEM

Project Based Learning

SACC Mandated Training

Safety (CPR/First Aid/AED)

Violence Prevention

Bullying Prevention

Parent Engagement

Student Engagement

Partnering With Community Based Organizations

How to use the Quality Self-Assessment tool effectively

Program Logic Model development

Effective Use of Advisory Boards

41

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Other (please specify):

134. What do you consider your greatest professional development need(s) at this time? Check all that apply.*

Youth Development

Mental Health Education

Social Emotional Learning

Classroom Management

Lesson Planning

NYS Learning Standards

STEM

Project Based Learning

SACC Mandated Training

Safety (CPR/First Aid/AED)

Violence Prevention

Bullying Prevention

Parent Engagement

Student Engagement

Partnering With Community Based Organizations

How to use the Quality Self-Assessment tool effectively

Program Logic Model development

Effective Use of Advisory Boards

42

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Programs are required to designate collaborative planning time for all program staff, which includeslead agency and partners, to plan program activities that correspond to the needs of the participantsand ensure that the entire program operates as one [Compliance Indicator D-4, SMV Report].

V(b): Collaborative Planning

NYS 21st CCLC Mid-Year Report: February 2020

135. How are you meeting collaborative planning time requirements for program staff and communitypartners?

*

43

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The Program Director and/or program staff are required to attend both fall and spring StateConferences [Compliance Indicator D-2, SMV Report].

V(c): State Conference Representation

NYS 21st CCLC Mid-Year Report: February 2020

136. Did you have representation at the required Fall 2019 conference hosted by the Technical AssistanceResource Centers?

*

Yes

No

44

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Fall 2019 Conference Representation Roles

NYS 21st CCLC Mid-Year Report: February 2020

Title/Role

Title/Role

Title/Role

Title/Role

137. Please indicate titles/roles of attendee(s) at the Fall 2019 Conference.*

45

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Fall 2019 Conference Representation

NYS 21st CCLC Mid-Year Report: February 2020

138. If you or a representative of your program did not attend the Fall 2019 Conference please indicate thereason(s) you were unable to attend.

*

46

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Spring 2019 Conference Representation

NYS 21st CCLC Mid-Year Report: February 2020

139. Did you have representation at the required Spring 2019 conference hosted by the Technical AssistanceResource Centers?

*

Yes, NYC Spring Conference

Yes, RoS Spring Conference

Yes, both NYC and RoS Spring Conferences

No

47

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Spring 2019 Conference Representation Roles

NYS 21st CCLC Mid-Year Report: February 2020

Title/Name

Title/Name

Title/Name

Title/Name

140. Please indicate titles/roles of attendee(s) at the Spring 2019 Conference.*

48

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Spring 2019 Conference Representation

NYS 21st CCLC Mid-Year Report: February 2020

141. If you or a representative from your program did not attend the required Spring 2019 Conference pleaseindicate the reason(s) you were unable to attend.

*

49

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Program administrative staff,school and partnering agency representatives, students (age-appropriate), parents and community members ALL must be represented on the programadvisory committee; they also must have meaningful involvement in program design, planning andassessment [Compliance Indicators G-5 and G-6, SMV Report].

VII: Advisory Board/Committee Information

NYS 21st CCLC Mid-Year Report: February 2020

142. How many times has your Advisory Board/Committee met this program year (July 2019 - February2020)?

*

Once

Twice

Three

Four

None

If None, please explain:

Other stakeholders (please specify)

143. Please list program stakeholders who regularly participate in Advisory Board/Committee Meetings.Check all that apply.

*

Program Staff

Program Administrators

School Administrators

Community Partners

Evaluator

Students

Parents

Community Members

50

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Programs are required to complete the Network for Youth Success Quality Self-Assessment (QSA) atleast two times each year [Compliance Indicator H-6, SMV Report]. The information gathered throughthis QSA process can be used to promote ongoing program improvement via action plans[Compliance Indicator H-6(d), SMV Report].

VIII: Program Quality Self-Assessment Tool

NYS 21st CCLC Mid-Year Report: February 2020

If No, when do you plan to review the tool?

144. Has your program utilized the Quality Self-Assessment (QSA) Tool yet this year?*

Yes

No

51

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VIII: Program Quality Self-Assessment Tool (continued)

NYS 21st CCLC Mid-Year Report: February 2020

Other (please specify):

145. How does your program utilize the QSA Tool? Check all that apply*

At staff meetings

At advisory board/committee meetings

Give to individuals to fill out on their own

Fill out the whole Tool at once

Focus on one or two elements at a time

146. Which elements of the QSA Tool (Third Edition) do you anticipate being most beneficial to the program inassessing its level of effectiveness during this year of programming? Check all that apply.

*

Element 1: Environment/Climate

Element 2: Administration/Organization

Element 3: Relationships

Element 4: Staffing/Professional Development

Element 5: Programming/Activities

Element 6: Establishes strong links to the school day

Element 7: Youth Participation/Engagement

Element 8: Parent/Family/Community Partnerships

Element 9: Program Sustainability/Growth

Element 10: Measuring Outcomes/Evaluation

Supplemental Element: Informal STEM learning

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Implementation is a process undertaken across multiple sites, involving the coordination of staff, andthe roll out of multiple services for both students and families. Implementation fidelity, asoperationally defined for this setting, refers to how well the programming that has been put in place atthis point in the year adheres to the program's plan described in the grant application or NYSED-approved program modifications [Compliance Indicator E-3,SMV Report].

For Core Activities that are reflected in Objectives and Performance Indicators (PIs) listed in yourTemplate for Goals and Objectives, adherence can be directly assessed based on the extent to whichmeasurable Objectives and PIs have been obtained. However, there are other required grantcomponents that may not be reflected in your Template for Goals and Objectives, specifically,Professional Development, and Alignment with the School Day. For these required components thatare not reflected in your Template of Goals and Objectives, adherence should be assessed based onhow closely your program activities align with what was described in your grant proposal or NYSED-approved program modifications.

IX: Program Implementation Fidelity

NYS 21st CCLC Mid-Year Report: February 2020

147. Have any program modifications been sent and approved by NYSED for this program year (since July2019)? If yes, please provide a summary.

*

No

If yes, please summarize.

Please upload your most current Goals and Objectives Template. If no approved changes, upload youroriginal.

No file chosen

148. Some programs have submitted program modifications since the beginning of the grant. Therefore aprogram must have an updated Goals and Objectives Template that is reflective of NYSED-approvedchanges.

*

Choose File

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Not Partial Full

Target Enrollment:Program is enrolling allgroups of identifiedstudents at the targetnumber, at the defineddosage of 30+ hours

Hours of Operation:Program is operating theminimum number of totalhours as specified in thegrant

Core AcademicServices: All activitiesspecified in the grantunder Core EducationalServices are beingimplemented at eachsite

Enrichment/YouthDevelopment Services:All activities specified inthe grant underEnrichment and SupportActivities are beingimplemented at eachsite

FamilyEngagement/LiteracyDevelopmentOpportunities: Allfamily engagement andliteracy activities arebeing offered, asspecified in the grant[Compliance IndicatorG-8, SMV Report]

149. Implementation fidelity, as defined for the NYS 21st CCLC programs, refers to implementing in alignmentwith the program's plan described in the original grant application or NYSED-approved program modifications.

Based on the above definition of implementation fidelity, please indicate your overall, program-wide level ofimplementation for each of the following required grant components. Use the following implementation scale:

Level (1) Not: Not yet implementing; developing capacity and planning to implement the componentsLevel (2) Partial: In the early stages of implementing the components program-wide, but not consistently, ornot at full schedule; and/or implementing at some sites, but not all. Level (3): Full: Fully implementing the components at ALL sites, consistent with the grant application and anyNYSED-approved program modifications that may apply.

*

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ProfessionalDevelopment: PDactivities are beingoffered, as specified inthe grant [ComplianceIndicators D-2, D-4, andD-5]

CommunityEngagement: Advisorymeetings are beingscheduled,communicated, andconvened four times peryear, as specified in thegrant [ComplianceIndicators G-5 and G-6]

Alignment with SchoolDay: All communicationactivities aligning theschool day content withthe program content arebeing implemented, asspecified in the grant[Compliance IndicatorsF-1, F-2, and F-3, SMVReport]

Not Partial Full

150. The Request for Proposal (RFP) for sub-grantees and Element 4 of the QSA, specify that programmanagement should include time for collaborative planning and PD, which should (1) be provided for programstaff and partnering organizations, (2) be in alignment with the goals and objectives of promoting qualityprogramming, (3) be in alignment with school and district goals, and (4) support college and career readiness[Compliance Indicators D-2, D-4, and D-5, SMV Report]. Briefly describe the status of your program's PDofferings in alignment with these expectations.

*

151. The RFP for sub-grantees, and Element 6 of the QSA, specify that programs should offer a cohesive,inter-related set of program activities and content that are designed to complement one another and arealigned and coordinated with: (1) the regular school day, (2) NYS Learning Standards, (3) school and districtgoals, and (4) preparing students for college and careers [Compliance Indicators E-2, F-1, F-2, and F-3].Briefly describe the status of your program's linkages to the school day in alignment with theseexpectations.

*

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Other alignment strategies (please specify)

152. OPTIONAL: Programs are responsible for establishing strong linkages with school day staff anddesigning programming to ensure it is aligned with school day curricula [Compliance Indicators E-2, F-1, F-2,and F-3]. We are interested in learning more about strategies different programs are using to align theirprograms with school day academics and NYS learning standards. If you feel your program has beensuccessful at this effort, please indicate which alignment strategies you have used. Check all that apply.

Collaboration with school-day teachers

Alignment with academic content in appropriate subjects

Appropriateness for targeted grade level(s) (with differentiation, where applicable)

Appropriateness for identified needs of targeted students (where applicable)

Alignment with content of that grade's curriculum

Alignment with state learning standards

Alignment with college and career readiness standards

153. OPTIONAL: For each of the alignment strategies you indicated in the previous question, please providesome specific examples where possible, and reference program activities where applicable.

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Programs are required to provide ongoing communication with families, and to engage them in theprocess of designing programming to meet their needs [Compliance Indicators G-1-G-8, SMV Report].

Student and Family Involvement

NYS 21st CCLC Mid-Year Report: February 2020

Other (please specify)

154. Describe how students are meaningfully involved in program design, structure and policy. Check all thatapply.

*

Student surveys

Focus groups

Advisory Board/Committee

Other (please specify)

155. Describe how families are meaningfully involved in program design, structure and policy. Check all thatapply.

*

Parent/Family Meetings

Parent/Family Surveys

Needs Assessment

Focus groups

Advisory Board/Committee

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Family Literacy

NYS 21st CCLC Mid-Year Report: February 2020

Other (please specify):

156. Please check any family literacy opportunities that you have offered this program year. Check all thatapply.

*

GED

ESL

Computer skills

Job readiness skills

Financial literacy

Family literacy

Parenting skills programs

Cultural programs

Other (please specify):

157. Please check any family literacy opportunities that you intend to offer this program year. Check all thatapply.

*

GED

ESL

Computer skills

Job readiness skills

Financial literacy

Family literacy

Parenting skills programs

Cultural programs

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The following questions are opportunities for Program leaders to share their valuable feedback basedon their program implementation experiences. The NYSED wants to learn about (A) all the wonderful,effective practices that are occurring at our NYS 21st CCLCs so we can celebrate those andcommunicate them statewide, as well as (B) any challenges you've faced or concerns you may haveso that we may work with our state-level team to try and address those areas of need.

Program Challenges, Successes/Promising Practices and Questions for the NYSED

NYS 21st CCLC Mid-Year Report: February 2020

Challenge(s):

Step(s) taken to resolvethe issue:

How can the NYSEDassist you further?

158. Briefly describe any unique challenge(s) that your program has faced thus far, and steps taken to resolvethe issue.

*

159. Briefly describe any success(es) or promising practice(s) that your program has experienced thus far andany steps/strategies taken to accomplish them.

*

160. List any remaining question(s) or concern(s) for the New York State Education Department program staff:

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