2012-13 MTSS GRANT APPLICATION

1790 E. Packard Hwy., Charlotte, MI 48813 . Telephone: 517.543.5500 . Fax: 517.543.4870

General Information:
District Name: Contact Person Name: Contact Person Email Address: School Address: City, State, Zip: Contact Person Telephone: Contact Person Fax: Oversight Contact: The Eaton ISD has identified the following MTSS initiatives that meet the funding objectives. If the project is listed below (proceed to Part 3 of this application). o o o
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Reading Street Intervention Programs Professional Development Specific to MTSS Other (please explain) _______________________________

Part 1: Goals of the Program (One page maximum)

a. Describe the goals for your proposed program. (As a result of this program, students will..) b. Describe how your program will enhance the Districts MTSS Initiative c. Describe the target population and the grade levels the program will serve. Explain why you have chosen this particular target population d. Describe the need for this activity and how this need will be assessed

Part 2: Program/Project Specifics (One page maximum)

a. Explain the program activities in one or two paragraphs emphasizing student learning and how the program provides opportunity for students b. Indicate how many students will be impacted by this program c. Describe the anticipated positive effect on student attitude, behavior and achievement d. Describe how this program meets the criteria of being creative and innovative e. Include any research related to the program f. Include a timeline for the program g. Explain how you intend to sustain the program beyond the grant period h. List any other organizations that will assist in the program i. Include a separate letter of support from your school district administrator

Part 3: Results and Evaluation (One page maximum)

a. Briefly describe how you will evaluate whether the program is meeting its goals, including what data will be

used. Be specific about how you will evaluate changes in students interest and knowledge b. Explain how progress will be monitored and measured on an on-going basis

Part 4: Program Budget

Time period of budget From: ______________ To: ______________ b. If you anticipate additional funding beyond this grant from your district, community or other sources, please list these below Indicate only the Expenses that apply to your project Program Expenses Salaries Fringe Benefits Instructional Materials Program Equipment (Remains with the Program) Supplies Printing/Copying Other (Explain Below) Totals Total Requested from this Grant Anticipated Funding From Other Sources

Total Expenses

Part 5: Annual Grant Reporting Requirements

If funded, you will be required to write a final report in a narrative format that addresses the following: a. What you believe was the most important outcome of this program for your organization and the community it was meant to serve b. What have you done, or do you plan to do, to insure that this program or activity continues c. Share an example of how this grant made a difference to those you serve. d. Offer suggestions for how EISD can improve the grant application process e. Final budget report with receipts attached

Assurances Statement
Principles: The overall goal of the MTSS Initiative is to define an integrated, multi-tiered system of instruction, assessment, and intervention designed to meet the achievement and behavioral needs of all learners. Eaton ISD has categorized the 11 essential components of MTSS into 5 Big Ideas: Leadership, Research & Evidence-Based Practices, Assessment and Data Collection, Problem-Solving and Data-Based Decision Making and Multi-Tier Service Delivery Model. Certification: I certify that the information submitted on this report is true and correct to the best of my knowledge. This report was prepared in cooperation with the business staff and the costs reported are proper charges for the intended purpose of this Eaton ISD grant. FOR THE DISTRICT ____________________________________ Signature Date FOR THE LEA/PSA ________________________________________ Signature Date