Even Start

William F. Goodling Family Literacy Grant 2005-2006

Form A Due: April 15, 2005

Agency/Program Name							U.S.Congressional District (circle one) 1 2 3 4 5
Address			City					Zip Code
Employee Federal Tax Identification Number (FTIN)			Amount of Federal Grant Funds Requested					Amount of Local Share Provided
Application for: (check one) o New Grant or o Continuation Grant o Requested for Years 4-8 o Requested for Years 9 and beyond
Total Grant (Fed + Local)				Estimated Number to be Served Children: Families:
Telephone Number		FAX Number		E-Mail
Project Title (if applicable)			Geographic Area Served (Counties or AEA)			Urban o Rural o		School District Number
Brief Description of Proposed Project (This description will be used to portray the project on the Department web pages. Please do not exceed this space.)
To the best of my knowledge, all data in this application are true and correct. The document has been duly authorized by the governing body of the applicant, and the applicant will comply with the attached assurances if the project is selected for funding.
Name of Head Administrator:				Title:				Telephone:
Signature:								Date:
Mailing Instructions:
	Please send the original and three (3) copies of this application to URGENT
Iowa Department of Education Attn: Haila Huffman Grimes State Office Building Des Moines, Iowa 50319 The application and copies must be received at the Department by: April 15, 2005.					Even Start has been eliminated from the President’s budget. This means that funding may not be available beyond September 2006. This grant is entirely dependent upon federal funding. Applicants should carefully weight their ability to provide comprehensive programming and the uncertainty of funding before completing this application.

Statement of Assurances

2005-2006

Form P – Program Assurances Due: April 15, 2005

Directions: This form is to be signed by the applicant agency and all significant partner agencies entering into direct collaboration on the project. Use an additional copy of the Assurances Form if the number of partners exceeds the space provided below.

The applicant partners agree:

1. To conduct activities described herein in accordance with applicable state and federal statutes and regulations, including those concerning non-discrimination, prohibitions against lobbying, suspension, and disbarment, the provision of a gun-free, drug-free and smoke-free work place, and access for persons with disabilities.

2. To use grant funds to supplement and, to the extent possible, increase the level of funds that would have been made available for the purposes described in the Request for Proposals. Grant funds will not be used to supplant services currently provided using state or federal funds nor for construction.

3. To participate in external evaluation of the project’s effectiveness as determined by the Department of Education.

4. The applicant assures that private non-profit schools have been invited to participate in planning and implementing the activities of this application when available and relevant to the Even Start Program.

5. To keep such records and provide such information to the Department of Education as reasonably may be required for fiscal audit and program evaluation.

6. To make all requests for budget revisions in writing prior to actual use of funds.

7. To notify the Department of Education of changes in management staff and/or contact person.

8. That all materials produced will include the following statement: (This project) is supported in part by a grant from federal and/or state funds administered by the Iowa Department of Education.

9. To comply with any/all expectations specifically identified and/or described in this Request for Proposal and the federal guidance.

Partner A – Agency/Program Name:

Telephone:

Signature of Head Administrator:

Title:

Date:

Partner B – Agency/Program Name:

Telephone:

Signature of Head Administrator:

Title:

Date:

Partner C – Agency/Program Name:

Telephone:

Signature of Head Administrator:

Title:

Date:

Partner D – Agency/Program Name:

Telephone:

Signature of Head Administrator:

Title:

Date:

Even Start Budget Summary Form B.1.

2005-2006

Applicant: Grant Year: 1-4 / 5-8/ 9+

The partner organization/s should be identified on this budget form. In-kind contribution may be cash or in-kind that is fairly evaluated and may be obtained from any source, included Federal sources other that Even Start.

100	Salaries		# of Staff	State Grant Amount	In Kind Amount	In Kind Descriptor
		Professional
		Full Time
		Part Time
		Total
		Other Personnel
		Full Time
		Part Time
		Total