Att. D Fillable Application Form.xlsx
XLSX spreadsheet 138 KB Posted
- Solicitation number
- S-58100-00016937
- Issued by
- Oregon
About this file
This is a fillable application form for the American Indian/Alaska Native Student Success Plan (AIANSSP) 2025-2030 Grant, administered by the State of Oregon to support tribal nations, educational organizations, and consortiums serving Native American and Alaska Native students. The application requires organizations to select one of five primary goals and associated objectives addressing tribal language revitalization, inequity in Native student data, Native excellence, holistic systems of support, or culturally responsive approaches. Applicants must complete five evaluation sections totaling 400 available points: Goal, Objective, Action Plan and Community (150 points); Service Area, Equity and Student Identity (100 points); Budget Form and Narratives (100 points); Assessment Plan (50 points); and Plan Students Served (up to 50 bonus points). Applications must be submitted through the Smartsheet portal by an authorized representative, with no hyperlinks permitted in submissions. The application requires detailed descriptions of proposed action plans, community engagement strategies, service area needs, and intersecting student identities, each limited to 1,000 words.
The grant provides up to $144,000 per award to support up to 10 grantees addressing student attendance, chronic absenteeism, and grade level transitions through community and parent involvement initiatives. The budget form requires itemized expenditures across categories including salaries and benefits, contracted services, office and student supplies and materials, professional development and training, partnerships or consortium member costs, and indirect costs capped at 10 percent of the federally-approved rate. Consortium applicants may combine plan student counts across member organizations and must identify each consortium member's contribution to the action plan. The application prioritizes the number of plan students served, with bonus points ranging from 15 points for 11-20 students to 50 points for 101 or more students. Applicants applying as consortiums must follow additional guidelines specified in the Request for Application (RFA) Section 1.3.1.
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Overview & Instructions Att. D - Fillable Application Form American Indian/Alaska Native Student Success Plan (AIANSSP) 2025-2030 Grant Application
| Organization Name: | [Enter the organization name] |
| Contact Name: | [Enter the contact name] |
| Contact Email: | [Enter contact email] |
| If applying as a Consortium, please enter all Consortium Members' Organization Names. | [Enter Consortium Member #1 Organization Name] |
| Add additional rows if necessary. | [Enter Consortium Member #2 Organization Name] |
| [Enter Consortium Member #3 Organization Name] |
| Overview |
| Applicants shall NOT provide links anywhere in Applications. Links will be redacted by the Single Point of Contact ("SPC") before the evaluation process begins and will not be evaluated. |
| Please submit any questions or requests for clarification before the deadline according to Section 1.4 Schedule and 3.1.2 Questions/Requests for Clarification of the RFA. |
Instructions:
1. Enter information in cells B3, B4 and B5 above. Enter information in cells B7-B9 as applicable if applying as a Consortium.
2. Complete the requested information in Sections 1, 2, 3, 4 and 5 of this Attachment D Fillable Application Form.
3. This Attachment D Fillable Application Form must be uploaded to the Smartsheet Application Submission https://app.smartsheet.com/b/form/019de552bfe97626bfe50ec0f76e1e35] portal by an authorized representative.
4. If an Applicant is applying as a Consortium, they must additionally follow the guidelines set out in Section 1.3.1 of the RFA.
| Section 1: | Goal, Objective, Action Plan & Community |
| Section 2: | Service Area, Equity & Student Identity |
| Section 3: | Budget Form & Narratives |
| Section 4: | Assessment Plan |
| Section 5: | Plan Students Served - Bonus Points |
| Reference: | AIANSSP 2025-2030 Goals & Objectives |
1-Goal, Obj, Act & Community
| Evaluation Item One - Goal, Objective, Action Plan & Community (150 Available Points Total) | Goal | Objective |
| Goal 1: Champion Tribal Languages | ERROR:#VALUE! | |
| Instructions: Select one AIANSSP 2025-2030 Goal and one Objective assocated with the Goal from the drop down menu that will be addressed through your proposed Action Plan. All five Goals and their associated Objectives are listed on the "Reference-Goals & Objectives" tab. | Goal 2: Address Inequity in Native Student Data | |
| Select one AIANSSP 2025-2030 Goal | Goal 3: Pursue Native Excellence | |
| Click into cell B5 and select from drop down arrow on the bottom right of the cell. | Goal 4: Cultivate Holistic Systems of Support | |
| Select one Objective associated with an AIANSSP 2025-2030 Goal | Goal 5: Center Culturally Responsive Approaches | |
| Click into cell B7 and select from drop down arrow on the bottom right of the cell. |
| Instructions: Describe the proposed Action Plan and how it will meet the AIANSSP 2025-2030 Goal and Objective. If applying as a Consortium, please explain how each Consortium Member will contribute to your Action Plan. |
| 1.1 Action Plan Description (50 Available Points) |
| [Enter text here. Limit 1,000 words] |
Instructions: Describe which community or communities you intend to serve through your proposed Action Plan. Your answer should include:
- the cultural, ethnic and linguistic identities of the community or communities you intend to serve,
- a description of the communities served (e.g. family or Elder engagement, community-wide events, etc.), and
- all grade levels served (Kindergarten only, K-3, etc.).
| 1.2 Community Description (50 Available Points) |
| [Enter text here. Limit 1,000 words] |
| Instructions: Describe how your organization will work with, listen to, and otherwise includes Plan Students, families, and community members in project design, implementation, and decision making. Your answer should include a reflection of consideration of the definition of Community Voice defined in Section 2.2.2. of the RFA and ensure your answer addresses existing staff, community Partnerships or cultural expertise that will support the success of this proposed Action Plan. Please also include how you will address communication or participation barriers to ensure authentic engagement opportunities for Plan Students and community members. |
| 1.3 Community Voice Description (50 Available Points) |
| [Enter text here. Limit 1,000 words] |
2-Serv Area, Equity & Stu Ident Evaluation Item Two - AIANSSP 2025-2030 Service Area, Equity & Student Identity (100 Available Points Total)
Instructions: Respond to the questions below to describe your proposed service area. Include data (quantitative or qualitative, such as data from local districts, national, listening sessions, survey, or research studies) to illustrate community needs. Your answer should include:
- The needs of Plan Students in your community, including existing programs or services for Plan Students in your community and how your proposed Action Plan will address gaps in service.
| 2.1 Service Area Needs (50 Available Points) |
| [Enter text here. Limit 1,000 words] |
| Instructions: Describe how your proposed Action Plan serves the needs of Plan Students with intersecting identities (e.g., race, ethnicity, gender identity, sexual orientation, disability, national origin, religion). Include specific intersecting Plan Student identities and strategies from your proposed Action Plan to support your claim. |
| 2.2 Plan Student Identities (50 Available Points) |
| [Enter text here. Limit 1,000 words] |
3-Budget Form & Narratives Evaluation Item Three - Budget Form & Narratives (100 Available Points Total)
| Instructions: Enter requested information in all applicable blue cells in the Budget Form below. Dollar amounts entered should include both direct and indirect costs. Indirect costs may not exceed 10% or Grantee’s federally-approved rate at the time the cost was incurred. | |
| If requesting an amount less than $144,000.00, please indicate here: | $0.00 |
| Budget Form | ||||
| Category | Description | |||
| Year One Budget | Other Funding Sources (if any) | Grand Total | ||
| Salaries/Personnel | Salaries | [Enter dollar amount] | [Type In] | [Enter dollar amount] |
| Benefits | [Enter dollar amount] | [Type In] | [Enter dollar amount] | |
| Contracted Services | e.g. Purchased Services | [Enter dollar amount] | [Type In] | [Enter dollar amount] |
| Office Supplies & Materials | Materials and supplies for office use | [Enter dollar amount] | [Type In] | [Enter dollar amount] |
| Office Equipment | Equipment for office use | [Enter dollar amount] | [Type In] | [Enter dollar amount] |
| Professional Development/Training | e.g. Registration fees | [Enter dollar amount] | [Type In] | [Enter dollar amount] |
| Student Supplies & Materials | Materials and supplies for student use | [Enter dollar amount] | [Type In] | [Enter dollar amount] |
| If Applicable, Parternships/Consortium Member Costs | Grant Funds to be Paid to Partnering Entit(ies) | [Enter dollar amount] | [Type In] | [Enter dollar amount] |
| Other (including any indirect costs not otherwise captured) | [Type in description of "Other" category] | [Enter dollar amount] | [Type In] | [Enter dollar amount] |
| # | Question | Answer |
| Instructions: Provide budget narratives below to explain the proposed Budget Form above. | ||
| 3.1 | Budget Narrative 1: Describe in detail how each proposed expenditure on the Budget Form is in line with the Action Plan proposed. Specifically address how the activities within your Action Plan are aligned to the selected AIANSSP 2025-2030 Goal and Objective. (50 Available Points) | [Enter text here. Limit 1,000 words.] |
| 3.2 | Budget Narrative 2: Identify the roles and responsibilities of staff who represent the Staffing category on the Budget Form. If applicable, ensure that your answer includes Contracting Services and funding paid to Partnerships/Consortium Members. (50 Available Points) | [Enter text here. Limit 1,000 words.] |
4-Assessment Plan Evaluation Item Four - Assessment Plan (50 Available Points Total)
Instructions: Describe what assessment tools will be used to monitor progress toward your AIANSSP 2025-2030 Goal and Objective, including what data will be collected to determine whether all activities within your Action Plan have been met. Specifically address how you plan to analyze and disseminate Action Plan outcomes with Plan Students and the community.
| 4.1 Assessment Plan (50 Available Points) |
| [Enter text here. Limit 1,000 words] |
5-Plan Students Served
| Evaluation Item Five - Bonus Points for Plan Students Served (Up to 50 Available Points) | Goal | Objective |
| Goal 1: Champion Tribal Languages | ERROR:#VALUE! | |
| Instructions: Select one tier based on how many Plan Students your Action Plan will serve. Up to 50 bonus evaluation points will be assigned in order to prioritize the highest number of Plan Students served. Consortium Applicants may select the tier that represents the total combined count of Plan Students Served among their Consortium, according to Section 4.3.1 of the RFA. | ||
| 5.1 Plan Students Served | ||
| Click into cell B5 and select from drop down arrow on the bottom right of the cell. | ||
| Goal 5: Center Culturally Responsive Approaches |
Reference-Goals & Objectives
| Goals | Objectives |
| Goal 1: Champion Tribal Languages | OBJECTIVE 1A: Uplift and Amplify Tribal Language Revitalization Efforts |
| OBJECTIVE 1B: Strengthen and Provide Holistic Support for Licensed Tribal Language Teachers and District Tribal Language Programs | |
| OBJECTIVE 1C: Support Districts with AI/AN+ Multilingual Learners (MLLs) | |
| Goal 2: Address Inequity in Native Student Data | OBJECTIVE 2A: Advance Equitable Identification of Native Students |
| OBJECTIVE 2B: Address Disparate Identification of Native Students in Special Education | |
| OBJECTIVE 2C: Increase Representation in Talented and Gifted Programs | |
| OBJECTIVE 2D: Address Disparities in Discipline, Suspensions, Expulsions, Exclusions, and Push Outs | |
| Goal 3: Pursue Native Excellence | OBJECTIVE 3A: Expand Culturally Responsive Early Literacy Practices |
| OBJECTIVE 3B: Strengthen Collaboration with Tribes and Families to Support Early Literacy | |
| OBJECTIVE 3C: Improve Graduation Rates Through Increased Enrollment in Career Connected Learning (CCL) and Career and Technical Education (CTE) | |
| OBJECTIVE 3D: Heighten Urgency that High School is the Foundation for Success in Post-Secondary Education | |
| Goal 4: Cultivate Holistic Systems of Support | OBJECTIVE 4A: Leverage Key Legislation in Support of Native Success |
| OBJECTIVE 4B: Honoring Educational Sovereignty through Tribal Consultation | |
| OBJECTIVE 4C: Invest in Targeted Programs Designed to Increase Outcomes for Native Students | |
| Goal 5: Center Culturally Responsive Approaches | OBJECTIVE 5A: Center Native Student Voices |
| OBJECTIVE 5B: Promote the Use of Culturally Appropriate Frameworks, Tools, and Practices to Support Native Youth Mental Health and Well-Being | |
| OBJECTIVE 5C: Provide Support to Educators to Successfully Implement Tribal History/Shared History Lesson Plans | |
| OBJECTIVE 5D: Continued Tribal History/Shared History Lesson Plan Development (K-12) and Curriculum Updates | |
| OBJECTIVE 5E: Promote the Implementation of Tribal Curriculum to Further Supplement Tribal History/Shared History Lesson Plans |
Data
| Goals | Objectives |
| Goal 1: Champion Tribal Languages | OBJECTIVE 1A: Uplift and Amplify Tribal Language Revitalization Efforts |
| Goal 1: Champion Tribal Languages | OBJECTIVE 1B: Strengthen and Provide Holistic Support for Licensed Tribal Language Teachers and District Tribal Language Programs |
| Goal 1: Champion Tribal Languages | OBJECTIVE 1C: Support Districts with AI/AN+ Multilingual Learners (MLLs) |
| Goal 2: Address Inequity in Native Student Data | OBJECTIVE 2A: Advance Equitable Identification of Native Students |
| Goal 2: Address Inequity in Native Student Data | OBJECTIVE 2B: Address Disparate Identification of Native Students in Special Education |
| Goal 2: Address Inequity in Native Student Data | OBJECTIVE 2C: Increase Representation in Talented and Gifted Programs |
| Goal 2: Address Inequity in Native Student Data | OBJECTIVE 2D: Address Disparities in Discipline, Suspensions, Expulsions, Exclusions, and Push Outs |
| Goal 3: Pursue Native Excellence | OBJECTIVE 3A: Expand Culturally Responsive Early Literacy Practices |
| Goal 3: Pursue Native Excellence | OBJECTIVE 3B: Strengthen Collaboration with Tribes and Families to Support Early Literacy |
| Goal 3: Pursue Native Excellence | OBJECTIVE 3C: Improve Graduation Rates Through Increased Enrollment in Career Connected Learning (CCL) and Career and Technical Education (CTE) |
| Goal 3: Pursue Native Excellence | OBJECTIVE 3D: Heighten Urgency that High School is the Foundation for Success in Post-Secondary Education |
| Goal 4: Cultivate Holistic Systems of Support | OBJECTIVE 4A: Leverage Key Legislation in Support of Native Success |
| Goal 4: Cultivate Holistic Systems of Support | OBJECTIVE 4B: Honoring Educational Sovereignty through Tribal Consultation |
| Goal 4: Cultivate Holistic Systems of Support | OBJECTIVE 4C: Invest in Targeted Programs Designed to Increase Outcomes for Native Students |
| Goal 5: Center Culturally Responsive Approaches | OBJECTIVE 5A: Center Native Student Voices |
| Goal 5: Center Culturally Responsive Approaches | OBJECTIVE 5B: Promote the Use of Culturally Appropriate Frameworks, Tools, and Practices to Support Native Youth Mental Health and Well-Being |
| Goal 5: Center Culturally Responsive Approaches | OBJECTIVE 5C: Provide Support to Educators to Successfully Implement Tribal History/Shared History Lesson Plans |
| Goal 5: Center Culturally Responsive Approaches | OBJECTIVE 5D: Continued Tribal History/Shared History Lesson Plan Development (K-12) and Curriculum Updates |
| Goal 5: Center Culturally Responsive Approaches | OBJECTIVE 5E: Promote the Implementation of Tribal Curriculum to Further Supplement Tribal History/Shared History Lesson Plans |
Sheet1
| Goals | Objectives | Plan Students Served |
| Goal 1: Champion Tribal Languages | OBJECTIVE 1A: Uplift and Amplify Tribal Language Revitalization Efforts | 11-20 Plan Students = 15 Bonus Points |
| Goal 2: Address Inequity in Native Student Data | OBJECTIVE 1B: Strengthen and Provide Holistic Support for Licensed Tribal Language Teachers and District Tribal Language Programs | 21-50 Plan Students = 25 Bonus Points |
| Goal 3: Pursue Native Excellence | OBJECTIVE 1C: Support Districts with AI/AN+ Multilingual Learners (MLLs) | 51-100 Plan Students = 35 Bonus Points |
| Goal 4: Cultivate Holistic Systems of Support | OBJECTIVE 2A: Advance Equitable Identification of Native Students | 101+ Plan Students = 50 Bonus Points |
| Goal 5: Center Culturally Responsive Approaches | OBJECTIVE 2B: Address Disparate Identification of Native Students in Special Education | |
| OBJECTIVE 2C: Increase Representation in Talented and Gifted Programs | ||
| OBJECTIVE 2D: Address Disparities in Discipline, Suspensions, Expulsions, Exclusions, and Push Outs | ||
| OBJECTIVE 3A: Expand Culturally Responsive Early Literacy Practices | ||
| OBJECTIVE 3B: Strengthen Collaboration with Tribes and Families to Support Early Literacy | ||
| OBJECTIVE 3C: Improve Graduation Rates Through Increased Enrollment in Career Connected Learning (CCL) and Career and Technical Education (CTE) | ||
| OBJECTIVE 3D: Heighten Urgency that High School is the Foundation for Success in Post-Secondary Education | ||
| OBJECTIVE 4A: Leverage Key Legislation in Support of Native Success | ||
| OBJECTIVE 4B: Honoring Educational Sovereignty through Tribal Consultation | ||
| OBJECTIVE 4C: Invest in Targeted Programs Designed to Increase Outcomes for Native Students | ||
| OBJECTIVE 5A: Center Native Student Voices | ||
| OBJECTIVE 5B: Promote the Use of Culturally Appropriate Frameworks, Tools, and Practices to Support Native Youth Mental Health and Well-Being | ||
| OBJECTIVE 5C: Provide Support to Educators to Successfully Implement Tribal History/Shared History Lesson Plans | ||
| OBJECTIVE 5D: Continued Tribal History/Shared History Lesson Plan Development (K-12) and Curriculum Updates | ||
| OBJECTIVE 5E: Promote the Implementation of Tribal Curriculum to Further Supplement Tribal History/Shared History Lesson Plans |
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