Att. D Fillable Application Form - Final 06.05.26.xlsx

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Attached to
RFA: American Indian / Alaska Native Student Success Plan
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 Program issued by the Oregon Department of Education Youth Development Division. The application requires organizations, tribes, educational entities, and consortiums to submit comprehensive proposals addressing one of five primary goals: Champion Tribal Languages, Address Inequity in Native Student Data, Pursue Native Excellence, Cultivate Holistic Systems of Support, or Center Culturally Responsive Approaches. Applicants must complete five evaluation sections including goal and objective selection, action plan and community engagement descriptions, service area needs assessment, budget forms with detailed narratives, and assessment plans. The RFA was posted on May 15, 2026, with applications due by June 17, 2026. Submissions must be uploaded to a Smartsheet portal by authorized representatives. Applicants must not include hyperlinks in submissions, as they will be redacted before evaluation. The contract term runs from July 1, 2026, through June 30, 2027, with an approved Action Plan due within 30 calendar days of grant execution.

The evaluation criteria total 400 available points distributed across five sections: 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 bonus points (up to 50 points, ranging from 15 points for 11-20 students to 50 points for 101 or more students). Grant awards total up to $144,000 per grantee, with up to 10 grants available for a total program funding of $1,440,000. Disbursements are structured at $100,000 upon approval of the Action Plan and $44,000 upon submission of the Final Report. Administrative costs are capped at fifteen percent for community-based organizations, culturally specific organizations, or early learning providers, and up to fifteen percent for tribes or their federally recognized indirect rates. Consortium applicants may combine plan student counts across member organizations. Funding derives from the Oregon Department of Education's General and State Funding sources and is contingent upon sufficient state appropriations.

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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)GoalObjective
Goal 1: Champion Tribal LanguagesERROR:#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 GoalGoal 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 GoalGoal 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. As allowable per OAR 581-017-0687, administrative costs, which include indirect costs, will be allowed as a percentage of the Grant funds disbursed as follows up to five percent for school districts, early learning hubs, or post-secondary institutions of education, up to fifteen percent for Community-Based Organizations, Culturally Specific organizations, or providers of early learning services and up to fifteen percent for Tribes or the Tribe’s federally recognized indirect rate, as provided in the grant agreement.
If requesting an amount less than $144,000.00, please indicate here:$0.00
Budget Form
CategoryDescription
Year One BudgetOther Funding Sources (if any)Grand Total
Salaries/PersonnelSalaries[Enter dollar amount][Type In][Enter dollar amount]
Benefits[Enter dollar amount][Type In][Enter dollar amount]
Contracted Servicese.g. Purchased Services[Enter dollar amount][Type In][Enter dollar amount]
Office Supplies & MaterialsMaterials and supplies for office use[Enter dollar amount][Type In][Enter dollar amount]
Office EquipmentEquipment for office use[Enter dollar amount][Type In][Enter dollar amount]
Professional Development/Traininge.g. Registration fees[Enter dollar amount][Type In][Enter dollar amount]
Student Supplies & MaterialsMaterials and supplies for student use[Enter dollar amount][Type In][Enter dollar amount]
If Applicable, Parternships/Consortium Member CostsGrant 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]
#QuestionAnswer
Instructions: Provide budget narratives below to explain the proposed Budget Form above.
3.1Budget 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.]
3.2Budget 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)GoalObjective
Goal 1: Champion Tribal LanguagesERROR:#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

GoalsObjectives
Goal 1: Champion Tribal LanguagesOBJECTIVE 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 DataOBJECTIVE 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 ExcellenceOBJECTIVE 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 SupportOBJECTIVE 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 ApproachesOBJECTIVE 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

GoalsObjectives
Goal 1: Champion Tribal LanguagesOBJECTIVE 1A: Uplift and Amplify Tribal Language Revitalization Efforts
Goal 1: Champion Tribal LanguagesOBJECTIVE 1B: Strengthen and Provide Holistic Support for Licensed Tribal Language Teachers and District Tribal Language Programs
Goal 1: Champion Tribal LanguagesOBJECTIVE 1C: Support Districts with AI/AN+ Multilingual Learners (MLLs)
Goal 2: Address Inequity in Native Student DataOBJECTIVE 2A: Advance Equitable Identification of Native Students
Goal 2: Address Inequity in Native Student DataOBJECTIVE 2B: Address Disparate Identification of Native Students in Special Education
Goal 2: Address Inequity in Native Student DataOBJECTIVE 2C: Increase Representation in Talented and Gifted Programs
Goal 2: Address Inequity in Native Student DataOBJECTIVE 2D: Address Disparities in Discipline, Suspensions, Expulsions, Exclusions, and Push Outs
Goal 3: Pursue Native ExcellenceOBJECTIVE 3A: Expand Culturally Responsive Early Literacy Practices
Goal 3: Pursue Native ExcellenceOBJECTIVE 3B: Strengthen Collaboration with Tribes and Families to Support Early Literacy
Goal 3: Pursue Native ExcellenceOBJECTIVE 3C: Improve Graduation Rates Through Increased Enrollment in Career Connected Learning (CCL) and Career and Technical Education (CTE)
Goal 3: Pursue Native ExcellenceOBJECTIVE 3D: Heighten Urgency that High School is the Foundation for Success in Post-Secondary Education
Goal 4: Cultivate Holistic Systems of SupportOBJECTIVE 4A: Leverage Key Legislation in Support of Native Success
Goal 4: Cultivate Holistic Systems of SupportOBJECTIVE 4B: Honoring Educational Sovereignty through Tribal Consultation
Goal 4: Cultivate Holistic Systems of SupportOBJECTIVE 4C: Invest in Targeted Programs Designed to Increase Outcomes for Native Students
Goal 5: Center Culturally Responsive ApproachesOBJECTIVE 5A: Center Native Student Voices
Goal 5: Center Culturally Responsive ApproachesOBJECTIVE 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 ApproachesOBJECTIVE 5C: Provide Support to Educators to Successfully Implement Tribal History/Shared History Lesson Plans
Goal 5: Center Culturally Responsive ApproachesOBJECTIVE 5D: Continued Tribal History/Shared History Lesson Plan Development (K-12) and Curriculum Updates
Goal 5: Center Culturally Responsive ApproachesOBJECTIVE 5E: Promote the Implementation of Tribal Curriculum to Further Supplement Tribal History/Shared History Lesson Plans

Sheet1

GoalsObjectivesPlan Students Served
Goal 1: Champion Tribal LanguagesOBJECTIVE 1A: Uplift and Amplify Tribal Language Revitalization Efforts11-20 Plan Students = 15 Bonus Points
Goal 2: Address Inequity in Native Student DataOBJECTIVE 1B: Strengthen and Provide Holistic Support for Licensed Tribal Language Teachers and District Tribal Language Programs21-50 Plan Students = 25 Bonus Points
Goal 3: Pursue Native ExcellenceOBJECTIVE 1C: Support Districts with AI/AN+ Multilingual Learners (MLLs)51-100 Plan Students = 35 Bonus Points
Goal 4: Cultivate Holistic Systems of SupportOBJECTIVE 2A: Advance Equitable Identification of Native Students101+ Plan Students = 50 Bonus Points
Goal 5: Center Culturally Responsive ApproachesOBJECTIVE 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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