Sample Business Proposals USDA Federal Government Grant Proposal

USDA Federal Government Grant Proposal

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The US Department of Agriculture Federal Government Grant Proposal is an example of a proposal using Proposal Pack to respond to a government RFP.

This is a good example to follow for any business or individual applying for government grants.

Length of Sample: 38 Pages
There are hundreds of templates to choose from in each Proposal Pack. This sample uses the following subset of Proposal Pack templates: Cover Sheet, Title Page, Table of Contents, Executive Summary, Needs Assessment, Statement of Work, Benefits, Innovativeness, System Plan, Cost Effectiveness, Project Summary, Capabilities, Qualifications, Financial Information, Sustainability, Legal Eligibility, Schematics, Contact Letter, Tab, Worksheet, Supplied Form

There are 105 complete sample proposals (including this one) in each Proposal Pack. The following related samples are also included in each Proposal Pack:
DOE Federal Government Grant Proposal
DOE Federal Government Grant Proposal #2
DOH Federal Government Grant Proposal
DOJ Federal Government Grant Proposal
DOJ Federal Government Grant Proposal #2
EPA Federal Government Grant Proposal
EPA Federal Government Grant Proposal #2
HHS Federal Government Grant Proposal
HHS Federal Government Grant Proposal #2

This sample illustrates how to write the following types of proposals:
Education, training proposal
Technical proposal
Service sales proposal
Project pitch proposal
RFP response
Federal government grant proposal

This sample was created with Proposal Pack for Government Grants

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The US Department of Agriculture Federal Government Grant Proposal is an example of a proposal using Proposal Pack to respond to a government RFP. This is an example of a Distance Learning and Telemedicine Grant proposal.

This is a good example to follow for any business or individual applying for government grants.
Companies and individuals responding to government grant RFPs.

Sample proposals are completed proposals you can use as a guide when writing your own unique business proposal. Samples illustrate how a collection of templates from one Proposal Pack design was assembled together into a framework and the details filled in to complete the proposal. Sample proposals are for illustration purposes intended only to show you how to assemble and layout a proposal. Samples are not intended to be copied as-is and they do not contain all of the information found in the Proposal Pack template collections.

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educational academic school training teaching retrain technical technology service project pitch company department RFP RFQ response federal government grant funding USDA sample example business proposal Tab Application for Federal Assistance page OMB webpage version Version Type Submission Preapplication Application Changed Corrected Application Type Application revision select appropriate letter New. Continuation Other Specify Revision Date Received Applicant Identifier Federal Entity Identifier Federal Award Identifier State Use Only Date Received State State Application Identifier Applicant Information Legal Name ABC College Consortium Employer Taxpayer Identification Number EIN TIN Organizational DUNS Address Street 40th Place Street City Redmond County King State Washington Province Country USA Zip Postal Code Organizational Unit Department Name Division Name Name and contact information for matters involving this application Prefix First Name John. Middle name Last Name Smith Suffix Title Provost Organizational Affiliation ABC College Telephone Number ext Fax Number mail Application for Federal Assistance pages and OMB webpage version Version Type Applicant ABC College Consortium 40th Place Redmond www abccc net Project Rural Distance Learning Prepared for Department Agriculture Office Distance Learning Telemedicine Prepared John Smith President Description ABC College Consortium application for funds provide demonstrate innovations teacher training using new equipment software training and connectivity residents five counties are IRS organization requesting the additional funds for projected budget for the total project Our current organizational budget The reason for the grant accelerate teacher and faculty proficiency with integrating advanced communications and information technologies associated with improved student achievement. Proposal Number CFDA page left intentionally blank Table Contents Tab Form Grant Cover Introduction Fixed Sites Non Fixed Sites Equal Opportunity Survey Tab Legal Eligibility Tab Executive Summary. Project Information Tab Project Summary Tab Telecommunications System Plan Schematics Scope Statement Work Tab Project Budget Kind Match Other Funds Tab Financial Information Sustainability. Statement Experience Tab Capabilities Qualifications Objective Scoring Tab Tab Rurality Fixed Sites Rurality Non Fixed Sites Tab NSLP Fixed Sites NSLP Non Fixed Sites Tab Leveraging Worksheets Tab. Subjective Scoring Tab Tab Additional NSLP Tab Needs Assessment Benefits Tab Innovativeness Tab Cost Effectiveness. Contact with USDA Tab State Director Letter Certifications Tab Architectural Barriers Flood Hazards Uniform Relocation Drug Free Workplace Debarment and Suspension Rules Lobbying Non Duplication Services Environmental Impact. Site Worksheet Fixed Sites Attachment See and Section the Application Guide Column For each Hub combined Hub End User and End User site show its complete official name and abbreviation should you choose use one Each site name abbreviation must used consistently throughout the balance your application Below the site name show the complete street address The address must one recognized Census American Factfinder the only address available for site Box Star Route Rural Route other address not recognized Factfinder give that address supplemented the precise latitude and longitude DDDD. Column For each site show how you designate the site Hub Hub End User End User. Column Show the County which the site located Column Show the School District which the site located Column Show the Congressional District which the site located example 57th Dist John Smith. Complete Site Name Abbreviation any Complete Street Address DDDD needed see instructions Site Designation County School District Congressional District. ABC College 40th Street Redmond HUB Name High School Name Street Address City State Zip Code End User Name Name. Middle School Name Street Address City State Zip Code End User Name Name. Elementary School Street Address City State Zip Code End User Name Name. PreK School Street Address City State Zip Code End User Name Name. You are not restricted sites continuation sheet follows this page you have many sites use many continuation sheets you need. Place this sheet behind under Tab your Application Site Worksheet Non Fixed Sites Continuation Complete Site Name Abbreviation any Complete Street Address DDDD needed see instructions Site Designation County School District Congressional District. Local Library Street Address City State Zip Code End User Name Name. Non Profit Partner Street Address City State Zip Code End User Name Name. Survey Ensuring Equal Opportunity for Applicants Reproduction OMB EXP Purpose The Federal government committed ensuring that all qualified applicants small large non religious faith based have equal opportunity compete for Federal funding order for better understand the population applicants for Federal funds are asking nonprofit private organizations not including private universities fill out this survey Upon receipt the survey will separated from the application Information provided the survey will not considered any way making funding decisions and will not included the Federal grants database While your help this data collection process greatly appreciated completion this survey voluntary Instructions for Submitting the Survey you are applying using hard copy application please place the completed survey envelope labeled Applicant Survey Seal the envelope and include along with your application package you are applying electronically please submit this survey along with your application. Applicant Organization Name ABC College Consortium Applicant DUNS Number Federal Program Distance Learning Telemedicine Grant Program CFDA Number Has the applicant ever received grant contract from How many full time equivalent employees does the the Federal government applicant have Check only one box For example two part time employees who each work half time equal one full time equivalent Yes employee the applicant local affiliate national organization the responses questions and should reflect the the applicant faith based organization staff and budget size the local affiliate Yes Self Identify the applicant secular organization fewer over Yes Self Identify What the size the applicant annual budget Check only one box Annual Budget means the amount money your Does the applicant have status status organization spends each year all such activities legal designation the Internal provided application ibl less than not Yes the applicant local affiliate national organization more Yes Self Explanatory Paperwork Burden Statement According the Paperwork Reduction Act persons are required respond collection information unless such collection displays valid OMB control number The valid OMB control number for this information collection The time required complete this information collection estimated average five minutes per response including the time review instructions search existing data resources gather the data needed and complete and review the information collection you have any comments concerning the accuracy estimate suggestions for improving this form please write the Agency Contact listed this grant application. Tab Legal Eligibility Name Applicant John Smith Organization ABC College Consortium 40th Place Redmond Whom May Concern Please advised that the attorney for ABC College Consortium which has its principle offices located Redmond behalf ABC College Consortium legal opinion based knowledge the legal status ABC College Consortium Washington State that now and has always been legally organized institution type here under Washington State law. legally organized institution higher education has the full legal power and authority take any and all actions allowable Washington State law and other applicable laws and regulations including legal authority contract with RUS accordance with those laws and regulations. any person entity has any questions regarding this opinion and the status ABC College Consortium described herein would happy address those questions. Sincerely Mary Smith Esq General Counsel Tab Executive Summary Project Information Abstract The ABC College Consortium located Washington composed counties and home million the state population The area contains three national parks its edges acres state and farmland bordering Oregon and the Pacific Ocean The once thriving region has declined since its manufacturing base disappeared Job losses and the slowing economy have sparked multiple needs education for example high demand for college degrees science and technology inadequate professional development technology integration for teachers and college faculty increase demand for accountability and growing gaps academic achievement. The purpose the project accelerate and sustain professional development technology integration for PreK college teachers resulting improved achievement for students The project combines distance learning face face web enabled instruction and mobile technologies enhance teacher ability improve the educational outcomes for students our region. Tab Project Summary Project Information Project Summary The main components our project are Create hub for the management coordination and maintenance low cost Internet platform that enables the development new elearning community able share content assess academic performance and create remedial solutions across multiple sites. Grow the number teachers and faculty capable with blended learning methodologies evaluations and solution fabrication. Offer equipment software and training upgrades students teachers social service professionals librarians parents business partners and community partners. Implement sustainable solution through the use change management toolkit and Improve student achievement mathematics science and language arts for students grades PreK. Overview Telecommunications System The ABC College Consortium will connect its members through hub hosted the College Equipment software mentoring and training will provided each site The three school districts libraries and social services agency will receive enhanced educational content applicable PreK students The hub will create content based needs generated through existing school district technology plans and community needs assessments ABC College will also provide location for business and community organizations access content collaborate communicate and guide authentic content for standards based curriculum The hub will offer opportunities for teachers conduct research and collaborate further across districts regionally statewide nationally and globally under the Blackboard Academic Suite Internet2 and Learning Guidebooks sponsored the Commonwealth Education Media Center for Asia and the Office Education for free online resources. ABC College already serves site for the Small Business Development Centers and One Stop Career Centers Redmond has agreed work with the regional Workforce Investment Board and other post secondary institutions promote regional plans develop talent through entrepreneurial outreach programs schools Working with the WIRED program from the Department Labor effort will made focus the Skills Competency Certification program for high growth jobs The hub will extend connections for the workforce development community and offer training opportunities conjunction with the goals the initiative. Institution with its SITES program National Action Council for Minorities Engineering and the National Engineers Week program enhance live action virtual field trips and site programs mathematics science and language arts Technical purchases will include. Infrastructure upgrades including wiring insure processing speeds network compatibility and software alignments enable distance learning all sites. Computers help students parents and social services professionals access enhanced supplemental programs web based instruction and coursework. Smart boards and related technology equipment enable upgrades multimedia content and provide site training teachers and applied professionals. Site Description The ABC College Consortium includes one hub and fourteen end user sites. How the project will address community needs why require financial assistance and how the project benefits rural residents. propose respond community needs document funding requests and detail project benefits rural residents through program management plan Planning teams the college school districts libraries and social service agencies conducted thorough needs assessments gathered and analyzed the results relative student achievement demographics and staff development Group technology plans reviewed existing instructional programs and materials and profiled community needs Based this process our collaborative plans field Virtual Team for the project trained together reflect their individual constituencies but collaborate decisions evaluate outcomes and communicate results regionally. Tab System Plan Telecommunication System Plan Scope Work Explanation types distance learning proposed statement that the project for distance learning and explanation how the project meets the regulatory definition distance learning. ABC College Consortium distance learning project collaboration between ABC College Redmond Public Schools Seattle Public Schools Public Library Social Services Agency and Bellevue Charter School connects students teachers parents other professionals businesses and community social service agency across rural areas using both telecommunications and information technologies The project uses curriculum defined and measured state standards aimed improvements language arts mathematics science and technology for students college three school districts and nonprofit grades PreK and registered users the County library applies new tools elementary secondary and postsecondary courses aimed advancing student achieve through blended learning methodologies tied going professional development for teachers and allied professionals serving our region. The Consortium uses standard distance learning strategies and applies best practices from successful national programs support blended learning implementation The standard distance learning categories include adaptation classroom content one site and transmittal other remote sites capture online coursework and extension online forums seminars and online catalogs for use teachers and staff The Centenary hub will provide partners with access courses that are not typically available our school sites These courses include advanced science mathematics and technology preengineering courses and additional foreign languages Students will also able attend live action programs virtual field trips beyond their rural environment and connect them global elementary secondary and tertiary education addition the program seeks cultivate local business and professional organizations further enhance and authenticate the current course content provided the target curriculum. Our innovation for the project comes two forms planning and executing Change Management Toolkit for educators business allied professionals and community leaders working upgrade the curriculum and distance learning our schools and effort network for virtual schools both the high school and elementary levels over the next three years use distance learning systems provide connectivity for our change management team provide Virtual High School and elementary programming. The change teams would involve student teacher and local mentors working together improve performance The virtual high school programs would also participate yearly forums onsite the college and host representative teams demonstrating the results their work for example website design and new ways managing class assignments college preparation techniques and small business ideas that are developed students. Video from all sites would developed using the distance learning equipment and would include team building activities meetings school programs and other activities that students not present could view home school laboratories Social Service Agency and Seattle Public Housing Authority sites Ultimately the expansion virtual programming leads interactions among students from our communities across the state and internationally. Schematics Map with Network Diagram Statement Work Scope Work Program Activities carried out Tab Overall Budget Worksheet See and Section the Application Guide Line Item Site Name Description Unit Cost Extended Cost DLT Use. ABC College Software ASP Services ABC College Hosting Services for Academic Suite ABC College Learning System ABC College ASP Hosting ABC College Customer Programming ABC College Infrastructure wiring cables connections equipment High School Smart Classroom equipment High School VHS Virtual High School Seats High School VHS Teacher Training Middle School Software Middle School Direct Response Support Middle School Smart Classroom equipment Elementary Full Curriculum Software Elementary Direct Response Support Elementary Site Training day Elementary Student Resource Materials Elementary Smart Classroom equipment Elementary Site Training day Elementary Student Resource Materials Elementary Early Reading Software Elementary Full Curriculum Software Elementary Direct Response Support PreK Social Service Smart Classroom equipment Library Smart Classroom equipment Housing Authority Smart Classroom equipment Overall Project Budget Page Subtotal Budget Summary Sum page and continuation sheets subtotals Overall DLT Project Budget4 documented under Tab Less Proposed Cash Match5 from Kind Match Worksheet Less Proposed Kind Match5 from Other Funds Worksheet Less Other Funds DLT Grant Request Place this Worksheet under Tab your Application Kind Match Worksheet See Section the Application Guide Proposed Matching Funds are generally cash any the line items shown the Overall Budget Worksheet are specified the match documentation they are kind Show them below the same manner line item site name description the Overall Budget Worksheet only portion attributable the DLT project show that portion here and the balance that not eligible the Other Funds Worksheet the right column clearly identify the source Remember document proposed matching funds under Tab otherwise they will not credited eligible match. Other Funds Worksheet See Section the Application Guide Some line items included DLT Project Budget are not eligible either grant match The funds for these must come from other sources and are designated Other Funds Some line items are only partially eligible grant match The balance these must also come from other sources Show all other funds below the same manner line item site name and description the Overall Budget Worksheet Show the ineligible line item cost portion thereof the other fund cost column adjacent the source that funding. Tab Financial Information Financial Information and Sustainability Description the project revenues and expenses The ABC College Consortium not revenue producing project instead seeks motivate improvements mathematics science and language arts engaging participants innovative communications and information technology tools Participants will experience cost savings via. Access high quality educational content low costs Ability participate professional development without the expense travel paying for substitutes and the costly experience inviting experts rural areas. Using virtual field trips live action experience through partners such the Smithsonian Institution and online courses available also provide new opportunities for both students and teachers explore communicate create assess and evaluate without today travel expenses. Collaboration among teachers and allied professionals should reduce fees for professional services teams realize savings sharing content resources and ideas and finally. Students can experience increase productivity when exploring new careers and opportunities working through the new eLearning community under development These new networks both human and digital will provide excellent alternatives current means for career exploration. Direct expenses are tied maintenance fees both equipment and software and anticipate those costs about per year. Evidence cost sharing arrangements among hub and end user sites applicable. All sites will share costs collaboration and consolidation expenses number areas for example. Expenses Cost Sharing Opportunities Systems support ABC College Consortium working through ABC College hub end user site provides enhanced expertise for members Using the Blackboard Academic Suite enables dramatic change systems integration maintenance and community opportunity work remotely reduce costs site meetings and personalize training that common framework enables members learn together and eliminate non alignment tools. Sustainability Insuring Sustainability designed this system for long term reliability and efficiency Equipment was selected that works with both ISDN and connections Additionally ABC College has been named Intel one the top colleges the nation for wireless Our Office Technology working with ITunesU Apple Intel IBM and others test and evaluate new approaches using new technologies This opportunity can shared with our partners well are planning Rate funding help streamline costs for maintenance connections Also the College seeks share one hundred computers turned and repaired into sign outs for parents and small businesses seeking upgrade their skills tune into the world their children. Demonstration how benefits including costs savings the DLT grant pass through those receiving the services from the project. The project was designed meet specific needs the communities served Tab Capabilities Statement Experience ABC College has distinguished history with innovation has been named one the top wireless colleges the nation Intel the fastest growing college New Jersey with enrollments expanding years top pick for college bound high school students and non traditional working adults The Centenary staff has experience with distance learning and has worked with students and community demonstrate innovations education The project will led. Carlos Jones Carlos Jones began his career the United States Army from the years While there attained the rank Sergeant First Class Airborne Infantry. From there began work with Kinney Systems Inc New York City Business Manager Systems Support Specialists provided support end user training database administration and VPN security company headquarters also developed database track financial performance individual parking facilities and the entire company. worked the Manager Information Technology for Intel Tempe managed multi platform and telecommunications network for the leading provider business consumer and targeted research and analysis company supporting users locations supervised programmers and network technicians reviewed their daily progress environment and evaluated networking and programming projects also oversaw systems setup daily backup connectivity virus inoculation performance tuning optimization troubleshooting and repairs also rebuilt the data infrastructure from inception through operation linked three offices with and Frame Relay technology and implemented ADP payroll system with Citrix Metraframe. went work for LaneLabs USA Inc Allendale New Jersey also Manager Information Technology While there managed the database and telecommunications network for the pharmaceutical company supporting sixty users rolled out the new Great Plains Dynamic accounting and new CRM Catalog package rebuilt the telecommunications package including disaster recovery for mission critical toll free numbers also rebuilt the data infrastructure and the call center. Since Jones has been employed ABC College the Chief Technology Officer guided the College its implementation the new Student Information System educational CRM and Blackboard software packages responsible for all technology one the fastest growing independent colleges Washington The institution has rated the Top colleges the United States with wireless network all four its campuses also rolled out Active Directory and upgraded infrastructure current technology built the wireless infrastructure implemented VoIP VPN Cisco Clean Access and Mirage inverted firewall also redesigned and upgraded Core Switching Cisco. Qualifications His technical competencies are vast including UNIX Linux Windows and Mac operating systems net and Java programming languages Oracle SQL Server DB2 and MySQL databases large array web technology development tools including Sublime Visual Source Safe WinRunner Visio Project and FastTrack hardware such Cisco Networking Mirage Packetteer Telephony and wireless technologies and proficient numerous network system management products like Tivoli TME UniCenter Track BMC Patrol Legato and Veritas products His objective has been and continues lead organization the development cutting edge solutions that enhance the way technology used also strives apply his experience information technology software product development and engineering improve his organization products services methods communication and problem solving strategies. Hughes holds Masters Business Administration degree from New York University and Bachelors Science degree Accounting from Rutgers University. John Smith the Provost and Chief Operating Officer ABC College addition his background building successful education programs business also expert medieval and renaissance literature Shakespeare Chaucer literary criticism linguistics and stylistics writing tutoring and composition. Smith holds Mathematics from Moravian College English Literature from Wake Forest University and Electrical Engineering from Rutgers University New Jersey. original work published Smith includes Pestilence Medieval and Early Modern English Literature published Routledge addition published number articles which have appeared The OWL Construction and Maintenance Guide Connecticut Review Modern Language Association The Writing Lab Newsletter and Essays Medieval Studies. Smith Redmond resident and active member the community has been County Chamber Commerce festival committee member since and currently serves the board directors also the public director the United Methodist Church. Superintendent Schools Robert Gray the Superintendent Schools and supervises the fourteen schools our network known state leader virtual programming and focused upgrading the credentials teachers and related professional staff using Smart Classrooms facilitate learning school home the community. Gray graduate Claremont College earned his master degree from Columbia University the School. Education focusing computer instruction and earned his doctorate the University California. His district has been singled out the NSF for inclusion upcoming grant advance mathematics science and computer science skills students grades through the region joint collaborative with local independent college county college and county vocational technical schools. Mrs Janice Trinkle Janice Trinkle the Associate Director for Social Services covering the five counties the grant application She directly supervises programs for low income families the region Her credentials include from Hunter College Master Degree Social Work from Rutgers University. The target interest for the Social Services agency are PreK Students from local housing authorities whose families earn less than per year The students identified will taken through home instruction with computers donated local colleges and software from the school district well class The agency has extended the school services full day educational and recreational programming for these students. Parents will involved through Podcasts for Parents programs which funded other grant monies State Department Education where they will receive equipment and software run the programming offered the Consortium This programming not only keeps parents abreast with PreK training but offers them window GED and post secondary programming also available through the Consortium. Tab Tab Rurality Worksheet Fixed Sites For more complete guidance completing this sheet see Section the Application Guide. Categorization Population Points Exceptionally Rural Any area the NOT included within the boundary fewer. Census Urbanized Area Urban Cluster having population excess This includes Urban Clusters between and well Census Rural Areas. Rural Any area the included within the boundary Census Urban Cluster having population over and not excess. Mid Rural Any area the United States included within the boundary Census Urban Cluster over and not excess. Urban Area Any area the United States included within the boundary any Urbanized Area Urban Cluster excess more. Enter each hub hub end user and end user site the table below Provide data for hubs Place pure hubs the beginning the list separated space and not include them your estimated Rurality score Use the table above determine points for each site document the numbers attach Census Fact Finder Urban Area map printouts and data sheets for each site showing precisely where the site relation the urban areas shown the map Any end user site without verifiable census documentation will evaluated urban zero points Remember that your sites must consistent throughout the application including the Rurality and NSLP Worksheets the Site Worksheet the Executive Summary the Telecommunications System Plan and the Budget the end user sites are not consistent your application unscorable and will returned ineligible. Applicant Estimated Rurality Score Sum Rurality Points End User Sites Rurality Worksheet Non Fixed Sites Site Name Location RuralitySite Type Census Census Same numbering and order Site NSLP Worksheets Hub etc PointsDesignation Population Number consecutively from previous sheet Elementary End User Mid Rural 15Seattle Elementary End User Mid Rural Seattle Elementary End User Mid Rural Bellevue Elementary End User Mid Rural Bellevue Elementary End User Mid Rural Redmond Library End User Mid Rural Seattle Housing Authority End User Mid Rural Seattle PreK Charter School End User Mid Rural Redmond Middle School End User Mid Rural Redmond Middle School End User Mid Rural Redmond Place Rurality Worksheets and Census Documentation under Tab your Application Tab NSLP Worksheet Fixed Sites For more complete guidance completing this sheet see Section the Application Guide. Decision Table site Eligible for NSLP Use NSLP for Specific School Use NSLP for School District where site located. Type End User Public School Yes Yes Private School Yes College Other Educ Org Yes All Others Hospital Public Library Clinic etc Yes Point NSLP Eligibility NSLP Zero NSLP NSLP NSLP Enter each site the table below placing them the same order the Site Worksheet and Rurality Worksheet. Identify the site type Provide data for hubs Place pure hubs the beginning the list separated space and not include them your estimated NSLP score The Decision Table above shows whether enter specific school district information for each site Remember that your sites must consistent throughout the application the end user sites are not consistent your application unscorable and will returned ineligible. The Agency will not research and confirm undocumented data Applicants must provide documentation for each site percentage with written certification from the organization that administers the NSLP your area that the data are accurate and the most recent available Some official NSLP data posted state websites you may provide printouts from these sites and enter the URL Data from unofficial websites not acceptable Place all NSLP certifications and any other documentation behind this Worksheet Any site without verifiable documentation will evaluated zero percent eligibility. Site Name Same numbering and order Site Rurality Worksheets Site Type Hub etc Total Students Eligible Source Attached Certified Data URL applicable. ABC College Hub End User www abccc net High School End User www abccc net Middle School End User www abccc net Elementary School End User www abccc net PreK Charter School End User www abccc net Average NSLP Sum NSLP Percentages Sites then rounded Integer Applicant Estimated NSLP Score Enter Points from Scoring Table NSLP Worksheet Non Fixed Sites Population Exceptionally Rural Any area the NOT included within the boundary fewer. Census Urbanized Area Urban Cluster having population excess This includes Urban Clusters between and well Census Rural Areas. Rural Any area the included within the boundary Census Urban Cluster having population over and not excess. Mid Rural Any area the United States included within the boundary Census Urban Cluster over and not excess. Urban Area Any area the United States included within the boundary any Urbanized Area Urban Cluster excess more. Enter every population center which you provide your service column Place each Census Urbanized Area UZA and Census Urban Cluster individual line and include data printouts from the Census showing the population each such area support the population you enter column you serve the entire urban area show the entire urban population column four you serve only part urban area enter that portion. Column Enter the entire Census Rural below population the service territory one line and show census data sheets support that number Show the census designation the population center column and enter the appropriate points from the table above column Enter the product column times column column You must include the entire population each Urbanized Area UZA and Urban Cluster which you provide your service column unless you demonstrate that your defined service territory excludes part the UZA Find additional guidance the Application Guide application for non fixed site project that does not include properly defined service territory documented census data can not scored and will returned ineligible. Service Territory Population Centers List each urbanized area urban cluster separate line Show the entire Census Rural Area one line Census Designation Census Population Population inService Territory Rurality Points Product. Sum Rows column including any additional rows from continuation sheets SUM. Tab Leveraging Worksheet Matching Funds For more complete guidance see Section the Application Guide The applicant must demonstrate eligible match least the grant request. credited the proposed match must for eligible purposes the Agency cannot fund item were the grant request cannot accept match. applicant you submit proposed match and estimated score The eligibility the match and actual score determined the Agency. You must document your matching funds described the Application Guide Place letters financial commitment and other match documentation along with this form under TAB your application package Each donor match listed below must supported matching letter you have more than ten donors use another copy this sheet and label continuation. Matches not properly documented under Tab will not credited Depending the consequent reduction your match this could lower your score make your project ineligible resultant match less than. Eligible Match Eligible Grant Request Points Match Match Match Match Match Donor place documentation letter from each donor behind this sheet Proposed Match. iii vii viii Total proposed matching contributions sum thru Total DLT Grant requested Match Percent Grant Request Line Line Applicant Estimated Leveraging Score Enter Points from Scoring Table Tab Worksheet USDA and Champion Community Worksheet See Section the Application Guide any your sites are located USDA Rural Empowerment Zone USDA Enterprise Community USDA Champion Community your application may eligible for points this category Check these websites for USDA designated areas. www ezec gov ezec mainmap html www ezec gov Communit champions html Ten points can earned least end user site within Additional sites located that another not earn additional points Five points can earned least end user site Champion Community Again additional sites located that another Champion community not earn additional points The maximum score applicant can earn this category fifteen points for having least one site and another site Champion Community Remember that the two categories are mutually exclusive There are areas that are both and Champion Community one site can not earn all fifteen points. List end user sites that are either Champion Community the appropriate table below Any end user site shown this Worksheet must consistent with the sites shown the Rurality and NSLP Worksheets document the Champion Community status the sites place printouts from the USDA websites shown above behind this Worksheet under Tab not documented under Tab points will awarded this category USDA designations use Census tracts The Census tract information for each available the Web page listed above You must supply the Census tract information you wish claim either status. End User Site Name Name Census Tract End User Site Name Champion Community Name Applicant Estimated EZEC Score Enter Points from Scoring Table Tab Tab Additional NSLP Worksheet See more complete information about additional NSLP see Section the Application Guide. The NSLP eligibility percentage our NSLP Worksheet Tab this percentage under and you believe your NSLP eligibility percentage does not accurately reflect the economic conditions your area compared other areas with similar eligibility percentages you have the option request additional points here the eligibility your NSLP Worksheet higher but you suspect that the percentage could drop below after Agency review your application you may also request these points Such request will acted upon only your final NSLP eligibility below determined the Agency Points awarded the Agency this category any are based the supporting information provided Attach your supporting documentation behind this worksheet under Tab. Requests for Additional NSLP will not considered not accompanied supporting documentation Additional NSLP points will awarded. hereby request additional NSLP Points and have attached documentation behind this Worksheet support request. Signature Authorized Representative Same person who signed the Application for Federal Assistance. Date Additional NSLP Points for Agency Use Tab Needs Assessment Community Needs Assessment and Project Benefits Define the Community The ABC College Consortium working collaborative schools libraries museums hospitals businesses government agencies and economic development professionals serving counties Connecticut and All are working spark the redevelopment area that has needed rebuild the area This project was developed education coalition within the Alliance Our group serves residents through fourteen schools social service agency and libraries. Benefits Direct Benefits number direct and related benefits can anticipated for the students teachers allied professionals parents and community targeted. Increase the number students with access the Internet organized instructional support online mentoring and authentic learning experiences relevant the business and professional communities seeking workers the 21st century. Increase the opportunities for professional development strengthen the technology integration instructional support and subject matter expertise teachers social workers and allied professionals involved with our schools. Work increase post secondary enrollments through advanced placement stronger ties community college and technical programs and involvement parents the career development planning for their children. Help improve retention and graduation rates Professional staff interaction and training with Change Management Team vested local politics. All students will have access through the Blackboard Academic Suite new courses educational content enrichment communications shared inquiry and larger eLearning community. Professional development time travel and costs will reduced There will increase the numbers students seeking post secondary education and. Efforts address low self esteem and lack confidence regarding educational attainment will supported through larger community experts and education partners. Related benefits include Participation the growth our regional economy Addressing the issues population decline with opportunities for youth become involved with more personalized educational experience. Growing the number qualified teachers and faculty Growing the community experience across the region sharing the effort improve the future for our youth and involve older community members that process. Document Support for the project provided experts the educational health care fields See documentation. Demonstrate that rural residents and other beneficiaries want the educational medical services from the project See attachments. Tab Innovativeness Innovativeness the Project are using two innovations during this project that will spark others. Change Management Toolkit helping school administrators teachers and allied professionals work Virtual Teams for common constituency have erased the school district boundaries and identified region instead the local focus which has been standard The Change Management Toolkit will provide the planners with key methodologies execute the deployment new equipment software and training and work sustain its deployment effectively also provides opportunity use cross functional teams address challenges schools. SMART Classrooms established each school district all are without motivate change the way both students and teachers interact with educational content The technologies used this approach enable video conferencing web enabled instruction Forums online coursework blogs wikis access Internet2 and other techniques What seen innovative that the technology will modified real time feedback and vendors put into competition they industry solve problems short term and not just sell equipment Also evaluations the classrooms will conducted with both students and teachers and feedback promoted through the Blackboard Academic Suite administered through the hub. Are there educational innovations proposed Yes organizational change strategies for the diffusion innovations and measurements technology integration management. Does the project use unique adaptations technology better meet the special needs the project proposed service area beneficiaries. Does the project have the potential influence promote changes how distance learning can delivered area Yes for New Jersey where people are still bound small town silos What innovative that have ignored the silos and planned though they are not obstacle instead used the small town technology plans that have been adopted their boards education provide impetus for regional solution that reduces cost and delivers communications efficiently and effectively. Does the project use existing resources new way Yes just through our deliberations have identified all the theatrical sites the rural area began dialogues with their directors collaborate programming and support local school. Tab Cost Effectiveness Cost Effectiveness the Project Discussions were held with vendors Alliance partners and financial professionals the College have made the decision purchase the equipment These challenges were considered. Tab John Smith State Director Department Agriculture Government Way Seattle Dear Smith This letter confirms our recent conversations regarding your planned grant application the Office Distance Learning and Telemedicine the USDA representative for these grants our state would like further encourage your plans move forward this grant linking several communities and providing missing technologies both schools and social services agencies. our first meeting was clear that your consortium was too small problem that you remedied later weeks and now you have expanded the collaborative include libraries museums and other public agencies that offer great opportunity expand access the public. are pleased the read your application and know that you will meet the requirements for submission. Sincerely Harry Jones State Director Tab Certificate Regarding Architectural Barriers All facilities financed with RUS grants that are open the public which physically handicapped persons may employed reside must designed constructed and altered readily accessible and usable handicapped persons Standards for these facilities must comply with the Architectural Barriers Act amended seq and with the Uniform Federal Accessibility Standards UFAS Appendix CFR subpart. prospective primary participant recipient financial assistance from RUS this organization commits carry out RUS established policy comply with the requirements the above referenced law the effect that all facilities must readily accessible and usable handicapped persons. The Grantee hereby certifies that prospective recipient under the Distance Learning and Telemedicine Grant and Loan Program compliance will compliance upon completion the project with the above referenced law. Date Type Print Name Title Certificate Regarding Flood Hazard Area Precautions accordance with CFR the project area subject flooding flood insurance must provided the extent available and required under the National Flood Insurance Act amended the Flood Disaster Protection Act amended applicable the insurance must cover addition the buildings any machinery equipment fixtures and furnishings contained the buildings RUS will comply with Executive Order Floodplain Management CFR Comp and CFR this chapter considering the application for the project. Please check the appropriate line below The project not located year flood plain therefore Flood Insurance required. The project located year flood plain and the required insurance will provided. The Grantee hereby certifies that prospective recipient under the Distance Learning and Telemedicine Loan and Grant Program compliance will compliance during construction and installation equipment and upon completion the project with the above referenced law. Date Uniform Relocation Assistance and Real Property Acquisition Policies Act Certification The Grantee assures that will comply with the Uniform Relocation Assistance and Real Property Acquisition Policies Act Uniform Act amended. and with implementing Federal regulations CFR and CFR Specifically the Grantee assuresthat Whenever Federal financial assistance used pay for any part the cost program project which will result the displacement any person. Fair and reasonable relocation payments and assistance shall provided for displaced persons. accordance with sections and the Uniform Act Relocation assistance programs offering the services described section the Uniform Act shall. provided displaced persons and Within reasonable period time prior displacement comparable replacement dwellings will available displaced persons accordance with section the Uniform Act Date Signature President Certification Regarding Drug Free Workplace Requirements for Grantees Other than Individuals This certification required the regulations implementing Sections the Drug Free Workplace Act. Title Subtitle seq CFR The grantee certifies that will will continue provide drug free workplace. Publishing statement notifying employees that unlawful manufacture distribution dispensing possession use controlled substance prohibited the grantee workplace and specifying the actions that will taken against employees for violation such prohibition. Establishing ongoing drug free awareness program inform employees about The dangers drug abuse the workplace The grantee policy maintaining drug free workplace Any available drug counseling rehabilitation and employee assistance programs and The penalties that may imposed upon employees for drug abuse violations occurring the workplace. Making requirement that each employee engaged the performance the grant given copy the statement required paragraph. Notifying the employee the statement required paragraph that condition employment under the grant the employee will. Abide the terms the statement and Notify the employer writing his her conviction for violation criminal drug statute occurring the workplace later than calendar days after such conviction. Notifying the Agency writing within calendar days after receiving notice under subparagraph from employee otherwise receiving actual notice such conviction Employers convicted employees must provide notice including position title every grant officer whose grant activity the convicted employee was working unless the Federal agency has designated central point for the receipt such notices Notice shall include the identification number each affected grant. Page Certification Regarding Debarment Suspension and Other Responsibility Matters Primary Covered Transactions This certification required the regulations implementing Executive Order Debarment and Suspension CFR. The prospective primary participant certifies the best its knowledge and belief that and its principals. are not presently debarred suspended proposed for debarment declared ineligible voluntarily. excluded from covered transactions any Federal department agency have not within year period preceding this proposal been convicted had civil judgment rendered against them for commission fraud criminal offense connection with obtaining attempting obtain performing public Federal State local transaction contract under public transaction violation Federal State antitrust statutes commission embezzlement theft forgery bribery falsification destruction records making false statements receiving stolen property. are not presently indicted for otherwise criminally civilly charged governmental entity Federal State local with commission any the offenses enumerated paragraph this certification and. have not within year period preceding this application proposal had one more public transactions Federal State local terminated for cause default. Where the prospective primary participant unable certify any the statements this certification such prospective participant shall attach explanation this proposal. Name and Title Authorized Representative Signature Organization Name Date Certification Regarding Lobbying for Contracts Grants Loans and Cooperative Agreements The undersigned certifies the best his her knowledge and belief that. Federal appropriated funds have been paid will paid behalf the undersigned any person for influencing attempting influence officer employee any agency Member Congress officer employee Congress employee Member Congress connection with the awarding any Federal contract the making any Federal grant loan the entering into any cooperative agreement and the extension continuation renewal amendment modification any Federal contract grant loan cooperative agreement. any funds other than Federal appropriated funds have been paid will paid any person for influencing attempting influence officer employee any agency Member Congress officer employee Congress employee Member Congress connection with this Federal contract grant loan cooperative agreement the undersigned shall complete and submit Standard Form LLL Disclosure Form Report Lobbying accordance with its instructions Copies this form may obtained from RUS. The undersigned shall require that the language this certification included the award documents for all sub awards all tiers including subcontracts sub grants and contracts under grants loans and cooperative agreements and that all sub recipients shall certify and disclose accordingly. This certification material representation fact upon which reliance was placed when this transaction was made entered into Submission this certification prerequisite for making entering into this transaction imposed. Any person who fails file the required certification shall subject civil penalty not less than and not more than for each such failure. Organization Name Name and Title Authorized Representative Signature Date Non Duplication Services Certificate prospective primary participant recipient assistance from RUS this organization commits carry out RUS established policy comply with the requirements that facilities using financial assistance will duplicate adequate established telemedicine services and distance learning services. The Grantee hereby certifies that prospective recipient under the said Distance Learning and Telemedicine Loan and Grant Program that will not use RUS grant funds duplicate any adequate established services referenced above. Date Environmental Impact Certification Environmental Project Summary This description should encompass all construction the project matter the source funding should provide details how the project will affect the environment wetlands farmlands floodplain cultural environment endangered species environmental quality and historic preservation additional space needed continue white bond paper and attach this certification. CERTIFICATION hereby certify that the construction proposed this application will not adversely impact the environment historic preservation Signature and Date Print Type Title.