| Charter Schools Program (CSP) |
| Office of Innovation and Improvement |
| U.S. Department of Education |
| CSP Data Collection Form |
| Instructions |
| Purpose of Data Collection: |
The new data collection will collect CSP grant award information from grantees (State Educational Agencies (SEAs) and non-SEAs) to create a new database of data from current applicants receiving a CSP grants. The CSP Data Collection Form will allow the U.S Department of Education (ED) to monitor CSP grant performance and analyze data related to accountability for academic performance and financial integrity. The data collection will assist in carrying out the purpose of the Charter School Program Section 5201 of the ESEA, which is to expand the number of high quality charter schools and increase the national understanding of the charter school model. |
| For Direct Grant Recipients: |
Charter schools (or other organizations) receiving CSP grants directly from the U.S. Department of Education are asked to complete the following worksheet entitled "Data Collection Form: Direct Grant Recipients." This form has two parts. Part A asks for confirmation of CSP non-SEA award information. The school/grantee name, contact person, and PR/award number has already been entered in the form. If this information is incorrect, please contact the data collection administrators (see "Contact Information" below). |
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Part B asks for specific CSP award information that is not included in your Grant Award Notification (GAN). Please provide the following information for your non-SEA award: 1) the name and contact information for the charter school and LEA; 2) the charter school's management organization (CMO, EMO or freestanding); 3) the charter authorizing agency; 4) the total amount of funding an applicant received to start a charter school, along with the beginning and end date of the grant project period and budget periods; and 5) other charter school information (e.g., enrollment) as needed. |
| Form Submission: |
Completed CSP Data Collection Forms should be sent to CSPdatacollection@wested.org. In the subject heading please include "CSP Data Collection" followed by your school name. Please be sure to save a copy of the completed form for your own records. |
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If an electronic copy cannot be sent, please send a paper copy of the completed data collection form to the following address: |
| WestEd |
| Attn: CSP Data Collection |
| 4665 Lampson Ave. |
| Los Alamitos, CA 90720 |
| Please be sure to make a copy of the completed form for your own records. |
| Contact Information: |
If you have any questions or concerns regarding the completion of the data collection form, please contact WestEd. You can email us at CSPdatacollection@Wested.org, or call toll-free 866-902-4887. |
| Paperwork Burden Statement: |
Public Burden Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 2.5 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefit (ESEA Section 5205). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or email ICDocketMgr@ed.gov and reference the OMB Control Number1855-0016.
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OMB Number: 1855-0016 Approval Expires 12/31/201X
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| Charter Schools Program |
| Office of Innovation and Improvement |
| U.S. Department of Education |
| Data Collection Form: Non-SEAs |
| Part A |
| School: |
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| School Contact Person: |
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| Title of Contact Person: |
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| PR/Award #: |
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| Project Period Begin Date: |
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| Project Period End Date: |
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Breakdown of Obligated Funds per Fiscal Year |
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Grant Award Amount |
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Supplemental Award Amount |
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| FY 2008 |
$0 |
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$0 |
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| FY 2009 |
$0 |
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$0 |
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| FY 2010 |
$0 |
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$0 |
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| FY 2011 |
$0 |
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$0 |
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| Total Award Amount Obligated: |
$0 |
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| Comments? If any of the above information is incorrect, or if you need to provide any additional information regarding your CSP grant, please use the box below. You may also direct comments to us at CSPdatacollection@Wested.org, or call toll-free 866-902-4887. |
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| Please turn to Part B to provide specific data for your grant |
| OMB Number: 1855-0016 Approval Expires 12/31/201X |
| Data Collection Form: Non-SEAs (continued) |
| Part B: CSP Grant Award Information |
| Part B asks for specific CSP award information that is not included in your Grant Award Notification (GAN). Please provide the following information for your non-SEA award: 1) the full name and contact information for the charter school (and charter developer, if different than the charter school); 2) The total amount of funding an applicant received to start a charter school; 3) the beginning and end date of the grant project period and budget periods; and 4) other charter school information as needed. |
| 1) Charter School Contact Information |
| Charter School Name and Contact Information |
Charter School Management Organization |
| Charter school name |
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Management Organization Type |
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| School NCES ID |
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Management Organization Name |
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| School mailing address |
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Management Organization address |
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| address line 1: |
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address line 1: |
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| address line 2: |
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address line 2: |
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| city: |
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city: |
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| state: |
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state: |
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| zipcode: |
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zipcode: |
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| LEA Information |
Charter School Authorizer |
| LEA name |
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Authorizer Type (choose one) |
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| LEA NCES ID |
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Authorizer Name |
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| LEA mailing address |
Authorizer mailing address |
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| address line 1: |
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address line 1: |
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| address line 2: |
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address line 2: |
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| city: |
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city: |
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| state: |
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state: |
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| zipcode: |
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zipcode: |
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| Does the charter school act as its own LEA? |
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| Is it an LEA with only charter schools? |
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| 2) Grant Award Information |
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Please provide the breakdown of funds obligated to this grantee from each Federal Fiscal Year. The total amount obligated across one or more years should equal the Total Award Amount provided on the left. |
| Project Period Begin Date |
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| Project Period End Date |
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| Total Grant Award Amount Obligated: |
$ |
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| In addition to providing the breakdown of funds obligated, please list the budget period for the time funds were obligated, and whether the awards were used for preplanning, planning, implementation or dissemination purposes. |
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FY 2011 |
FY 2010 |
FY 2009 |
FY 2008 |
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| Dollar amount of grant award |
$ |
$ |
$ |
$ |
| Beginning date of grant budget period |
mm/dd/yy |
mm/dd/yy |
mm/dd/yy |
mm/dd/yy |
| End date of grant budget period |
mm/dd/yy |
mm/dd/yy |
mm/dd/yy |
mm/dd/yy |
| Type of grant (choose one) |
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| 3) Charter School Operation |
| School year in which the school first enrolled students |
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| School enrollment in 2004-05 (if not opened, enter "0") |
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| School enrollment in 2005-06 (if not opened, enter "0") |
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| School enrollment in 2006-07 (if not opened, enter "0") |
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| School enrollment in 2007-08 (if not opened, enter "0") |
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| School enrollment in 2008-09 (if not opened, enter "0") |
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| School enrollment in 2009-10 (if not opened, enter "0") |
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| School enrollment in 2010-11 (if not opened, enter "0") |
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| School enrollment in 2011-12 (if not opened, enter "0") |
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| Comments? If you need to provide any additional information regarding this CSP subgrant, please use the box below. You may also direct comments to us at CSPdatacollection@Wested.org, or call toll-free 866-902-4887. |
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| Thank you very much for your cooperation. |
| OMB Number: 1855-0016 Approval Expires 12/31/201X |