dlt-worksheets-fy-25.xlsx
XLSX spreadsheet 53 KB Posted
- Attached to
- Distance Learning and Telemedicine Grants
- Opportunity number
- RUS-25-01-DLT
About this file
This is an Excel workbook template containing multiple worksheets for applying to the FY2025 Distance Learning and Telemedicine (DLT) Grant Program administered by USDA Rural Utilities Services. The worksheets include templates for Description of Project Sites, Rurality Calculation, Economic Need Calculation, Special Consideration, Match Calculation, and Line-Item Budget.
The worksheets are designed to help applicants document key program requirements including: classification of hub and end-user sites in rural areas; calculation of rurality scores (minimum 20 points required for eligibility) based on census population; economic need scoring based on county poverty rates; special consideration points for projects serving tribal lands, distressed communities, or socially vulnerable communities; matching fund requirements (minimum 15% match); and detailed line-item budgets for grant-funded equipment and in-kind contributions. The templates are blank samples intended to be filled out by grant applicants as part of their submission package.
FY2025 DLT Worksheets
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Other files
| File | Type | Posted |
|---|---|---|
| fy-25-dlt-app-guide.pdf | ||
| dlt-checklist-fy-25.xlsx | XLSX spreadsheet | |
| fy-25-dlt nofo.pdf |
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Text version
Description of Project Sites SAMPLE Description of Project Sites Worksheet
| (Insert additional rows as needed) | |||||||
| Site Number | Site Name | Site Designation (Hub; End-User; | |||||
| Hub/End-User) | Street Address | Town | County | State | 5 Digit ZIP | Congressional District | # Rural Residents Served at each Hub/End-User or End-User Site |
Hub Sites: A hub site is a facility that is part of a network or telecommunications system that provides educational or medical services to end-user sites. A pure hub receives no end-user benefits. The site is usually a connection management point or is exclusively an educational or medical source of distance learning or telemedicine. Hub sites located in non-rural areas are not eligible for grant assistance unless they are necessary to provide DLT services to rural residents at end-user sites.
End-User Site: An end-user site is a facility that is part of a network or telecommunications system that is utilized by end-users. For a site to be included as an end-user site for scoring purposes, the applicant must demonstrate equipment purchased will be installed or placed at the site.
A Hub/End-User site performs both functions: a hub which also accommodates end-users.
See Application Guide Section B and Appendix A for additional information.
Rurality Calculation
| SAMPLE Rurality Calculation Worksheet | ||
| 0 | ||
| (Insert additional rows as needed) | ||
| Minimum Score of 20 points is required for eligibility | ||
| Site Number | Site Name | Site Designation |
(Hub; End-User;
| Hub/End-User) | Town or Place Name | Census Population | Is the Site in a Town contiguous to City or Town | |
| > 50,000? | Name of Adjacent Urban City or Town (if Yes in prev. col. ) | Rurality Score | ||
| Yes | ||||
| No |
Project's Rurality Score (Sum of Points for all sites with End-Users/Total # of all sites with End-Users)
| Scoring Table | |
| Census Population | Points |
| EXCEPTIONALLY RURAL AREA - 5,000 or less | 40 |
| RURAL AREA - 5,001-10,000 | 30 |
| MID-RURAL AREA - 10,001-20,000 | 20 |
| URBAN AREA - Over 20,000 or Adjacent to City > 50,000 | 0 |
NOTE: Enter the hub, end-user, and hub/end-user sites in the same order as shown on the Description of Project Sites Worksheet.
Please complete all columns for every site.
ONLY use the information associated with End-User and Hub/End-User sites in the Rurality Calculation. Should RUS determine that a hub site was misclassified, hub information will be required.
See Application Guide Section D-1 and Appendix A for additional information.
Economic Need Calculation
| SAMPLE Economic Need Calculation Worksheet | ||
| 0 | ||
| (Insert additional rows as needed) | ||
| Site Number | Site Name | Site Designation |
(Hub; End-User;
Hub/End-User) County SAIPE Percent Poverty, All Ages Economic Need Score
| Applicant's Estimated Economic Need Score |
| (Sum of Economic Need Points /Sum of End-User + Hub/End-User Sites) |
| Scoring Table | |
| SAIPE County Poverty Percentage: | Points |
| Poverty % < 10% | 0 |
| 10% ≤ Poverty % < 20% | 10 |
| 20% ≤ Poverty % < 30% | 20 |
| 30% ≤ Poverty % | 30 |
NOTE: Enter the hub, end-user, and hub/end-user sites in the same order as shown on the Description of Project Sites Worksheet.
Please complete all columns for every site. ONLY enter the SAIPE poverty percentage associated with each end-user and hub/end-user site.
See Application Guide Section D-2 and Appendix A for additional instructions.
Special Consideration
| SAMPLE Special Consideration Worksheet |
| 0 |
| Before Completing this Worksheet, PLEASE CAREFULLY READ: |
Section E, (d), (i) - (iii) of the 2025 DLT NOFO and Section D of the Application Guide
| Under the FY 2025 DLT NOFO, does this project qualify for special consideration points? | YES | NO |
| If the anwer above is NO, skip the remainer of the sheet. | ||
| If the anwer above is YES, complete the table below. |
Special Consideration Category Category for Which Applicant is Seeking Special Consideration Points (10 Points Maximum)
ONLY MARK ONE Other Special Consideration Categories Addressed by this Project** (No additional points)
| MARK ALL THAT APPLY | Site Number(s) | Site Name(s) | |
| One or more End-User(s) serving Distressed Communities | |||
| One or more End-User(s) serving Socially Vulnerable Communities | |||
| One or more End-User(s) serving Tribal Lands | |||
| Project proposed by a federally recognized Tribe (including Tribal instrumentalities and entities wholly owned by Tribes) |
** For tracking purposes only
Special Consideration points will only be awarded if the application Executive Summary supports the claim that the project is proposed by a federally recognized Tribe, including Tribal instrumentalities and entities wholly owned by Tribes; or has at least one end-user site in the following areas: Tribal Lands, Distressed Communities, Socially Vulnerable Communities. List which site number(s) and name(s) will include an end-user site serving Tribal Lands, Distressed Communities, or Socially Vulnerable Communities.
If a DLT project proposes service on or over Tribal Lands and the applicant is non-Tribal, then a letter of consent is required from each Tribal Council with jurisdiction over the Tribal Lands in question. However, if a DLT project proposes infrastructure construction or deployment on or over Tribal Lands, then a Tribal Resolution is required from the Tribal Government with jurisdiction over the Tribal Lands in question. Review the NOFO and DLT Application Guide for additional details.
Match Calculation
| SAMPLE Match Calculation Worksheet | ||
| 0 | ||
| (Insert additional rows as needed) | ||
| Donor | Proposed Cash ($) | Proposed In-Kind ($) |
| (Documentation Letter from each donor must be provided) |
| 1. Total Proposed Matching Contribution (must equal Line B + Line C in the Budget Worksheet) | $ - 0 | $ - 0 | $ - 0 |
| 2. Total DLT Grant Request (Must equal Line D in the Budget Worksheet) | $ - 0 | ||
| Match Percent (Line 1 ÷ Line 2), must be at least 15% of Grant Request |
Budget
| SAMPLE Line-Item Budget Worksheet | |||||
| 0 | |||||
| (Insert additional rows as needed) | |||||
| Items being funded by Grant and Cash Match | |||||
| Line Item # | Site Number & Name | Description | Unit Cost | # of Units | Extended Cost |
| 1 | $ - 0 | ||||
| 2 | $ - 0 | ||||
| 3 | $ - 0 | ||||
| 4 | $ - 0 | ||||
| 5 | $ - 0 | ||||
| 6 | $ - 0 | ||||
| 7 | $ - 0 | ||||
| 8 | $ - 0 | ||||
| 9 | $ - 0 | ||||
| 10 | $ - 0 | ||||
| 11 | $ - 0 | ||||
| 12 | $ - 0 | ||||
| 13 | $ - 0 | ||||
| 14 | $ - 0 | ||||
| 15 | $ - 0 | ||||
| 16 | $ - 0 | ||||
| 17 | $ - 0 | ||||
| 18 | $ - 0 | ||||
| 19 | $ - 0 | ||||
| 20 | $ - 0 | ||||
| 21 | $ - 0 | ||||
| Total Grant and Cash Match | $ - 0 | ||||
| Items being contributed as In-Kind Match (if applicable) | |||||
| Line Item # | Site Number & Name | Description | Unit Cost | # of Units | Extended Cost |
| 1 | $ - 0 | ||||
| 2 | $ - 0 | ||||
| 3 | $ - 0 | ||||
| 4 | $ - 0 | ||||
| 5 | $ - 0 | ||||
| 6 | $ - 0 | ||||
| 7 | $ - 0 | ||||
| 8 | $ - 0 | ||||
| 9 | $ - 0 | ||||
| 10 | $ - 0 | ||||
| Total In-Kind Match | $ - 0 | ||||
| A | Overall DLT Project Budget (Sum of Total Grant & Cash Match and Total In-Kind Match) | $ - 0 | |||
| B | Less Proposed Cash Match (As documented on Match Calculation Worksheet) | $ - 0 | |||
| C | Less In-Kind Match | $ - 0 | |||
| D | DLT Grant Request (A-B-C) | $ - 0 | |||
| Grant to Match % (minimum of 15% required) |
File details come from the government source that posted it. Updated .