| Charter Schools Program (CSP) |
| Office of Innovation and Improvement |
| U.S. Department of Education |
| CSP Data Collection Form - Non-SEA Grantees |
| 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 authorized public chartering agency; 4) the total amount of funding an applicant received to start a charter school, along with the amount of funds expended and 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: |
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. The valid OMB control number for this information collection is 1855-0016. The time required to complete this information collection is estimated to average 127 hours per response, including the time to review instructions, search existing data resources, 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, D.C. 20202-4537. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: U.S. Department of Education, Office of Innovation and Improvement 400 Maryland Avenue, S.W., LBJ-4W227, Washington D.C. 20202-2800. |
| OMB Number: 1855-0016 Approval Expires 2/28/2015 |
| 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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Administrative Expenditures |
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| FY 2011 |
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| FY 2012 |
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| FY 2013 |
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| FY 2014 |
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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 2/28/2015 |
| Data Collection Form: Non-SEAs (continued) |
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| Part B: CSP Grant Award Information |
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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 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. |
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| 1) Charter School Contact Information |
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| Charter School Name and Contact Information |
Charter School Management Organization |
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| 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 |
Authorized Public Chartering Agency |
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| 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 and Expenditures Information |
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Please provide the breakdown of funds obligated to this grantee from each Federal Fiscal Year and the amount of funds expended. The total amount obligated across one or more years should equal the Total Award Amount provided on the left. |
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| 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 2014 |
FY 2013 |
FY 2012 |
FY 2011 |
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Totals |
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| Dollar amount of grant award |
$ |
$ |
$ |
$ |
$0.00 |
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| Total amount expended to date |
$ |
$ |
$ |
$ |
$0.00 |
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| Anticipated expenditures through end of FY |
$ |
$ |
$ |
$ |
$0.00 |
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| Beginning date of grant budget period |
mm/dd/yy |
mm/dd/yy |
mm/dd/yy |
mm/dd/yy |
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$0.00 |
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| End date of grant budget period |
mm/dd/yy |
mm/dd/yy |
mm/dd/yy |
mm/dd/yy |
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The remainder above is the carryover amount |
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| Type of grant (choose one) |
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| 3) Charter School Operation |
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| School year in which the school first enrolled students |
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School enrollment (if not opened, enter "0") |
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Number of students on waitlist to enroll each year (if not opened, enter "NA") |
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| School enrollment and waitlist figures in 2006-07 |
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| School enrollment and waitlist figures in 2007-08 |
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| School enrollment and waitlist figures in 2008-09 |
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| School enrollment and waitlist figures in 2009-10 |
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| School enrollment and waitlist figures in 2010-11 |
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| School enrollment and waitlist figures in 2011-12 |
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| School enrollment and waitlist figures in 2012-13 |
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| School enrollment and waitlist figures in 2013-14 |
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| School enrollment and waitlist figures in 2014-15 |
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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. |
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| OMB Number: 1855-0016 Approval Expires 2/28/2015 |
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