FE_25-44-ED_Fredonia_High_School.pdf

PROJECT TITLE:

PROJECT MOMENTUM

AZ SUPPORT

INTERGOVERNMENTAL

AGREEMENT (IGA)

IGA No: 25-44-ED

ARIZONA DEPARTMENT Of

EDllCATJON

1535 W. Jdferson, Bin Ii 3i Phoenix. Arizona 85007

(602) 364-25 I 7

Effective Date: Upon Execution

Termination Date: June 30, 2026

Pursuant to Arizona Revised Statutes (A.RS.)§ 11-952 et seq. this Intergovernmental Agreement is entered into by the Arizona Department of Education ("ADE"), an agency of the State of Arizona, and Fredonia- Moccasin Unified District (Fredonia High School) ("CONTRACTOR"). Pursuant to A.R.S. § 11-951 et seq. both parties are authorized to enter into agreements for the joint exercise of any power common to the contracting parties as to governmental functions necessary to the public health, safety and welfare, and the proprietary functions of such public agencies.

Therefore the ADE and the CONTRACTOR agree to abide by all the terms and conditions set forth in this agreement.

For and on behalf of the CONTRACTOR:

City Fredonia

Address 221 E Hartt Street

State Arizona

Zip Code 86022

For and on behalf of the Arizona Department of Education

1535 W Jefferson Street, Bin# 37

Phoenix, Arizona 85007

Signature of Person Authorized to Sign Date

Braulio Garcia

Chief Procurement Officer

INTERGOVERNMENTAL AGREEMENT DETERMINATION

In accordance with A.R.S. § 11-952, this agreement has been reviewed by the undersigned who has determined that this ag eement is in appropriate form and within the powers and authority granted to the respective public body.

Signature

Name/Title

Date

Jay Arnold (Dec 10, 2025 09:29:05 MST) Jay Arnold https://azedsign.na1.echosign.com/verifier?tx=CBJCHBCAABAAaNDetP8rPynJMzG7W1gcU2ESmlzl0nMu https://azedsign.na1.echosign.com/verifier?tx=CBJCHBCAABAAaNDetP8rPynJMzG7W1gcU2ESmlzl0nMu

IGA No. 25-44-ED Arizona Department of Education

1535 W Jefferson, Bin # 37 Phoenix, Arizona 85007

1. Purpose of Agreement

The State and the LEA’s desire to improve student achievement in Math and ELA by increasing the effectiveness of teachers through targeted and collaborative action. To achieve this goal, the State will fund district coaches, school principal partners, aligned professional training, and virtual collaborative team support needed to implement the school improvement actions specified within the Project Momentum Arizona Framework. The parties recognize that the agreement will require collaboration, guidance and support from qualified service providers with specific knowledge, skills and experience aligned with the Project Momentum Arizona Framework to ensure fidelity of implementation. The intention of Project Momentum Arizona is to ensure that Arizona educators will have developed the shared understanding and full capacity to close gaps in student learning in and advance academic outcomes in Math and ELA into the future.

2. Term of Agreement

This agreement is effective Upon Execution through June 30, 2026 and can be renewed in accordance with Section 3, or be terminated in accordance with Sections 9 and 11.

3. Renewal of Agreement

This agreement may be renewed for additional terms, upon agreement of the CONTRACTOR and ADE, and by both parties signing an Amendment extending this Agreement. ADE shall prepare the Amendment for additional periods for both parties’ signatures.

4. Scope of Services

ADE and the CONTRACTOR shall perform the obligations agreed to by each as set forth in Attachment “A,” Scope of Work attached hereto and incorporated herein by reference.

5. Payment

As payment for full and satisfactory performance of the services, the ADE agrees to pay the CONTRACTOR as outlined in Attachment “B” Price Sheet.

6. Changes

This agreement may only be changed in writing and must be signed by both parties and their duly authorized agents (an Amendment). In the event that state or federal law enacted after the effective date of this agreement conflicts with any term of this agreement, controlling law will apply and supersede that/those term(s).The parties agree to promptly consider an appropriate Amendment to the agreement to remove each conflict.

7. Arbitration

Both parties agree to resolve all disputes arising out of or relating to this agreement through arbitration, after exhausting applicable administrative review, to the extent required by A.R.S.

§ 12-1518, except as may be required by other applicable statutes.

8. Breach

This agreement may be terminated by either party if the other party fails to fulfill its obligations.

9. Termination

Except as otherwise provided, this agreement may be terminated without cause upon thirty

(30) days written notice by either party.

10. Governing Law

This agreement shall be governed and interpreted by the laws of the State of Arizona, and to the extent applicable, the Arizona Procurement Code (A.R.S. § 41-2501, et seq.) and the administrative rules promulgated thereunder (A.A.C. R2-7-901 et seq.).

11. Non-Availability of Funds

Every payment obligation of the Arizona Department of Education (ADE) under this agreement is conditioned upon the availability of funds appropriated or allocated for the payment of such obligation. If funds are not allocated and available for the continuance of the agreement, this agreement may be terminated by the State at the end of the period for which funds are available. No liability shall accrue to ADE in the event this provision is exercised, and ADE shall not be obligated or liable for any future payments or for any damages as a result of termination under this paragraph.

12. Cancellation for Conflict of Interest

Pursuant to A.R.S. § 38-511, the State of Arizona (“State”), its political subdivisions or any department or agency of either may, within three years after its execution, cancel any contract (agreement), without penalty or further obligation, made by the State, its political subdivisions, or any of the departments or agencies of either if any person significantly involved in initiating, negotiating, securing, drafting or creating the contract on behalf of the State, its political subdivisions or any of the departments or agencies of either is, at any time while the contract (agreement) or any extension of the contract (agreement) is in effect, an employee or agent of any other party to the contract (agreement) in any capacity or a consultant to any other party of the contract (agreement) with respect to the subject matter of the contract(agreement). A cancellation made pursuant to this provision shall be effective when either party receives written notice of the cancellation unless the notice specifies a later time.

13. Non-Discrimination

The Contractor shall comply with State Executive Order Nos. 2023-09, 2023-01, 2009-09, and any and all other applicable Federal and State laws, rules and regulations, including the Americans with Disabilities Act. Contractor shall include these provisions in contracts with Subcontractors when required by Federal or State law.

14. Records

Pursuant to A.R.S. §§ 35-214 and 35-215, the CONTRACTOR shall retain and shall contractually require each subcontractor to retain all data, books and other records ("Records") relating to this agreement for a period of five years after completion of the agreement. All Records shall be subject to inspection and audit by the State at reasonable times. Upon request, the CONTRACTOR shall produce the original of any or all such Records.

15. Compliance Requirements for A.R.S. § 41-4401, Government Procurement: E-Verify Requirement

A. The contractor warrants compliance with all Federal immigration laws and regulations relating to employees and warrants its compliance with Section A.R.S. § 23-214, Subsection A. (That subsection reads: “After December 31, 2007, every employer, after hiring an employee, shall verify the employment eligibility of the employee through the E- Verify program.)

B. A breach of a warranty regarding compliance with immigration laws and regulations shall be deemed a material breach of the contract and the contractor may be subject to penalties up to and including termination of the contract.

C. Failure to comply with a State audit process to randomly verify the employment records of contractors and subcontractors shall be deemed a material breach of the contract and the contractor may be subject to penalties up to and including termination of the contract.

D. ADE retains the legal right to inspect the papers of any employee who works on the contract to ensure that the contractor or subcontractor is complying with the warranty under paragraph A.

16. Confidentiality

ADE and CONTRACTOR may choose, from time to time, in connection with work contemplated under this agreement, to disclose confidential information to each other (Confidential Information). All such disclosures must be in writing and marked as Confidential Information.

The Parties shall not disclose to unauthorized third parties any Confidential Information of the other Party and will use such information only for the purposes of this Agreement, and for three

(3) years after the termination of this agreement; provided that the receiving Party's obligations hereunder shall not apply to information that: (A) is already in the receiving Party's possession at the time of disclosure; or, (B) is or later becomes part of the public domain through no fault of the receiving Party; or, (C) is received from a third party with no duty of confidentiality to the disclosing party; or, (D) was developed independently by the receiving party prior to disclosure;

or, E. is required to be disclosed by law or regulation.

Any information that is transmitted orally or visually, in order to be protected hereunder, shall be identified as such by the disclosing party at the time of disclosure, and identified in writing to the receiving party, as Confidential Information, within thirty (30) days after such oral or visual disclosure. The CONTRACTOR shall retain the right to refuse acceptance of such Confidential Information that is not required for the purposes of this agreement.

Both parties agree to comply with the federal Family Educational Rights and Privacy Act of 1974. This applies to all provisions of this agreement which involves identifiable individual student data.

17. Property of the State

Title and exclusive copyright to all reports, information, data, curricula, materials, and software prepared by CONTRACTOR in performance of this agreement shall vest in the State of Arizona.

18. Public Record

Both parties recognize that work product developed under this agreement become public information, except as limited by section 17, “Confidentiality.”

19. Notices

All written communications shall be addressed and mailed or personally served as follows:

To the CONTRACTOR:

To ADE:

Contractor Name: Dorene Mudrow, Superintendent Address: 221 E Hortt Street, Fredonia, 86022 Telephone: 928-643-7333 Email: dmudrow@fredonia.org

Procurement, Bin # 37

1535 West Jefferson Phoenix, AZ 85007 Telephone: (602) 364-2517 Fax: (602) 364-0598 Email: procurementinbox@azed.gov

Technical Contact: Natasha Camp Telephone: (602) 542-9551 Email: natasha.camp@azed.gov

20. Documents Incorporated By Reference

The Uniform Terms and Conditions are incorporated into this document by reference, and may be obtained by visiting:

Uniform Terms and Conditions_r10.5_03-24 for the Terms and Conditions mailto:dmudrow@fredonia.org mailto:procurementinbox@azed.gov mailto:natasha.camp@azed.gov https://spointra.az.gov/sites/default/files/Uniform%20Terms%20and%20Conditions_r10.5_03-24.pdf

INTERGOVERNMENTAL AGREEMENT

ATTACHMENT A – SCOPE OF WORK

IGA Number: 25-44-ED

1. Mission Statement The Arizona Department of Education is a service organization committed to raising academic outcomes and empowering parents.

2. Background The State and the LEA’s desire to improve student achievement in Math and ELA by increasing the effectiveness of teachers through targeted and collaborative action. To achieve this goal, the State will fund district coaches, school principal partners, aligned professional training, and virtual collaborative team support needed to implement the school improvement actions specified within the Project Momentum Arizona Framework. The parties recognize that the agreement will require collaboration, guidance and support from qualified service providers with specific knowledge, skills and experience aligned with the Project Momentum Arizona Framework to ensure fidelity of implementation. The intention of Project Momentum Arizona is to ensure that Arizona educators will have developed the shared understanding and full capacity to close gaps in student learning in and advance academic outcomes in Math and ELA into the future.

3. Description of Project

ADE shall provide :

• District coaching services

• Principal partner services

• Reimbursement for professional development aligned to the Project Momentum Framework Gears

• Virtual collaborative team services (as applicable)

4. CONTRACTOR Responsibilities

• The LEA accepts that the project seeks to align the operational practices of the school system with effective evidenced-based instructional strategies shown to have the highest impact in terms of increasing and sustaining quality outcomes for all Arizona students. See the Project Momentum Arizona Framework.

Such improvement efforts require change. The LEA agrees to engage these actions in good faith to advance student achievement.

• The LEA will include advancing student outcomes on state and federally mandated assessments in English Language Arts and mathematics as part of its operational goals. The success criteria for the project requires participating schools to demonstrate student performance growth in these tested areas at a rate greater than that of the state. The results will be used to benchmark successful schools and share effective strategies.

• The LEA will work to ensure that its strategic planning and direction align with the purpose and tenets of the project. Clarity around shared expectations and actions allows for cohesive leadership in pursuit of achieving project goals.

• LEA leaders commit to making effective project implementation a top priority. The LEA superintendent will adhere to all project requirements including systemic planning, implementation, monitoring, and evaluation. LEA leaders, including the superintendent, agree to actively engage in project training and regularly conduct short-cycle classroom observations to provide constructive feedback aligned with achieving project goals.

• The LEA commits to implement school improvement actions required to improve student achievement with fidelity to the Project Momentum Arizona Gears Framework. These actions include a thorough root-cause analysis to determine primary needs, development of plans aligned with the project model to address identified needs, and the ongoing collection of evidence needed to act in accomplishing project goals. The LEA will deploy an effective standards-based curriculum and a balanced assessment system including common interim/benchmark assessments aligned to the standards taught within the district pacing guide for the quarter or trimester. The LEA will implement two required benchmarks (Grades: 4,6,7 Mathematics and Grades: 3,5,8 ELA) using the state designated assessment system. These benchmarks will be administered to specified grade-level students within a designated timeline. The LEA will work to ensure that operations are well-understood by instructional staff and that practices are realistic and manageable. If the LEA chooses an external educational service provider to work in conjunction with the actions required by the project, the LEA representative will provide ADE with a full description of the services to be provided, clear rationale for implementation and an evidenced-based evaluation of the intended services. The integration of these services should be fully addressed within the required quarterly reporting. ADE reserves the right to examine the impact of service integration and withdraw grant participation if it determines that a conflict exists with project requirements.

• The LEA will develop or adjust structures and schedules for shared collaborative time dedicated to advancing the Project Momentum Framework within the contracted school day or weekly calendar to support the effective operations of departmental and/ or grade-level teams. Such operations should be clearly observable as part of the LEA master schedule.

• The LEA will identify key teacher leaders and administrators to help advance the work of the project. Such work may include strategic planning, training, team collaboration, development of instructional resources and delivery of intervention support to help close gaps in student learning.

• The LEA will engage assigned, experienced support consultants to serve as a district coach and a principal partner for each participating school. All district coaches and principal partners will have met the criteria established by the Arizona Department of Education (ADE) and successfully completed the ADE training for their roles. The LEA agrees to have ADE provide support services for such roles.

• The LEA shall develop an action plan for Project Momentum implementation using the required reporting template. LEA progress will be updated quarterly in accordance with the dates specified in the guiding agreement. Quarterly reports will include implementation goals for each participating school developed collaboratively with the principal and principal partner. In addition, a summary of school and district actions will be completed collaboratively with the district coach and LEA superintendent, or designee.

• The LEA will engage in the project to include a recurring series of action meetings. Participating principals will engage in a virtual meeting with their principal partner at least twice monthly and in person during six site visit days during the school year. The LEA superintendent or designee will engage virtually with the district coach at least once monthly, or as needed, and in person during at least one site visit. Meeting activities will include developing an operational plan for the project, establishing a professional development plan aligned with district priorities and the Project Momentum Arizona Framework, completing the required Quarterly Report and providing oversight to participating school(s) as they engage the work.

• To measure the effectiveness of the project, the LEA will collect data on student achievement and make this information available in aggregate to ADE. Data will be reported, as appropriate, within the required quarterly reports. The data will be used to target and provide support where needed to close gaps in student learning. The LEA may elect to engage assistance from the project data specialist to help meet these requirements. The data support specialist will have met the criteria established by the Arizona Department of Education and successfully completed the ADE training for this role.

• The LEA agrees to share the process protocols and products of its project work to help advance the effectiveness of other schools in improving outcomes for all students. If requested by ADE, the district will help catalog these resources in an online repository in accordance with the procedures established by

ADE.

5. Manner of Financing

ADE shall: fund costs associated with the activities referenced in Section I

• Pay for district coaching services

• Pay for principal partner services

• Reimburse for professional development aligned to the Project Momentum Framework Gears up to $7,000.

• Pay for virtual collaborative team services (as applicable).

6. Required Reports

The LEA shall submit quarterly programmatic reports to the ADE for all expenditures incurred under this Agreement. The report deadlines are the 15th of the month following each Fiscal Quarter, e.g. July 1 – September 30, 2025, report period is due October 15, 2025

The format for these reports will be developed by the ADE with input and agreement from the LEA to ensure proper reporting of quantifiable impact metrics as required under Federal guidance.

To measure the effectiveness of the Program, the ADE may collect data on student achievement at any time before, during and after the Program. The ADE agrees that it will maintain confidentiality of all identifiable student data in accordance with the requirements of the Family Educational Rights and Privacy Act (“FERPA”). The ADE reserves the right to utilize the aggregated and de-identified data collected during the term of this Agreement consistent with the limitations of FERPA.

INTERGOVERNMENTAL

AGREEMENT

ATTACHMENT B – PRICE SHEET

1. Payment(s) to CONTRACTOR. The method of payment, time of payment, and source of funds are:

Method: Invoice

Source of funds: SSAE150

Amount shall not exceed $7,000.00

2. The CONTRACTOR shall submit completed ADE FORMs-701d and 701b (subject to modification by the program office).

3. If indirect cost is included, the CONTRACTOR shall submit a copy of the Indirect Cost Approval letter from its cognizant agency for such indirect cost. Indirect cost may be restricted or disallowed on some projects. Check with the appropriate program office for more information.

4. If the CONTRACTOR expends $750,000 or more in federal funds, the CONTRACTOR shall have an audit performed pursuant to OMB Circular A-133 and submit the results of that audit to ADE within 9 month of the end of the CONTRACTOR’S fiscal year.

ATTACHMENT C – INTELLECTUAL PROPERTY

IGA Number:

25-44-ED

• CONTRACTOR Materials and Inventions. As between the parties, CONTRACTOR shall own all rights, title, and interests, in and to: all CONTRACTOR Materials and Inventions, including all patents, copyrights, trade secrets, and any other intellectual property rights pertaining thereto; all changes, modifications, updates or enhancements thereto made by CONTRACTOR; and all derivative works therefrom. CONTRACTOR shall grant to ADE for the duration of the term of the agreement a nonexclusive, worldwide right and license to copy, distribute, transmit, display, perform, create derivative works from, sub-license and otherwise use and exploit the CONTRACTOR Materials, in any medium now known or hereafter developed, provided that ADE and CONTRACTOR shall negotiate in good faith a mutually agreeable arrangement for an appropriate licensing fee payable to CONTRACTOR for any such license that will allow CONTRACTOR to recover any of its direct, out of pocket development costs in such CONTRACTOR Materials. To the extent any such license to ADE relates to CONTRACTOR Materials licensed from a third party and such third party license permits use of the Materials outside of the scope of this agreement or Statement of Work without any additional incremental charge, then the license between ADE and CONTRACTOR shall likewise not include any additional incremental charge (over and above cost recovery for CONTRACTOR) with respect to such Materials. Except as otherwise requested or approved by CONTRACTOR, ADE shall cease all use of the CONTRACTOR Materials upon expiration or termination of the agreement, and shall immediately return or destroy the same at CONTRACTOR’s direction.

• ADE Materials and Inventions. From time to time, ADE may provide CONTRACTOR with certain ADE

Materials. ADE shall own all rights, title, and interests in and to: all ADE Materials and Inventions including all patents, copyright, trade secrets, and any other intellectual property rights pertaining thereto; all changes, modifications, updates or enhancements thereto made by ADE or CONTRACTOR; and all derivative works therefrom. ADE hereby grants to CONTRACTOR a revocable, nonexclusive, non-assignable, non-transferable, worldwide limited right and license to copy, distribute, transmit, display, perform, create derivative works, sublicense and otherwise use and exploit the ADE Materials for the performance of the Services hereunder. The foregoing license does not give CONTRACTOR, and CONTRACTOR is not authorized, to sublicense such ADE Materials. Except as otherwise requested or approved by ADE, CONTRACTOR shall cease all use of the ADE Materials upon expiration or termination of the agreement, and shall immediately return or destroy the same at ADE’s direction.

• Joint Inventions. During the term of this agreement, the parties jointly may conceive of Inventions relating to the provision of Services hereunder. In such event, CONTRACTOR and ADE shall jointly own any such Invention. All rights, title, and interests are jointly and equally shared by the CONTRACTOR and the ADE. In the event that such Inventions relate to Materials licensed from a third party and such third party requires fees for said Materials, each party shall be responsible for covering the costs of their use of these third party Materials outside the scope of this agreement. To the extent any such Inventions relates to Materials licensed from a third party and such third party license permits use of the Materials outside of the scope of this agreement or Statement of Work without any additional incremental charge, then likewise, there shall be no additional incremental charge to either party by the other with respect to such Materials.

• Defined Terms. For purposes hereof, the following terms have the following meanings:

• “Invention” shall mean any idea, design, concept, technique, process, machine, discovery or improvement, whether or not patentable, conceived of or made solely or jointly by CONTRACTOR and CONTRACTOR’s employees, or jointly by CONTRACTOR and CONTRACTOR’s employees with one or more employees of ADE, during the term of this agreement and in the performance of this agreement, provided that either the conception or reduction to practice thereof occurs during the term of this agreement and in the performance of the agreement.

• “Materials” shall mean any computer software, computer programs, architecture, computer functionalities, computer interfaces, computer code, computer files, images, photographs, designs, forms, data listings, or compilations or databases, graphics, artwork, text or writings, documents, abstracts and summaries thereof or any other related items or information reasonably required for the performance of the Services.

“Materials” include Materials created by or for ADE (“ADE Materials”) and Materials created by or for CONTRACTOR (“CONTRACTOR Materials”).

ADE FORM-701d (FEB 01) 6

ARIZONA DEPARTMENT OF EDUCATION

INTERAGENCY SERVICE AGREEMENT BUDGET/ESTIMATED

NEEDS PAYMENT SCHEDULE FOR INSTITUTIONS OF HIGHER

EDUCATION, STATE AGENCIES AND OTHER AGENCIES.

INSTRUCTIONS:

Submit original to ADE Contracts Management Unit as part of proposed Agreement/amendment..

A. AGREEMENT IDENTIFICATION FOR THE BUDGET PERIOD From Upon Execution To June 30, 2026

1. Applicant Agency: Fredonia

Elementary School

2. Contact Person: Dorene Mudrow, Superintendent Phone No.: 928-643-7333

3. Agreement No.:

25-44-ED

4. Funding source (Chapter 1, etc.):

CFDA No.: SSAE150

5. Date submitted:

6/11/2025

Index No.:

6. Proposal Name (If any):

7. Check ONE [ x ] New [ ] Renewal Application [ ] Completion Report [ ] Amendment [ ] ADE Revision

B. AGREEMENT BUDGET

*EXPENDITURE CATEGORIES

BUDG

ET

(1)

REQUEST CHANGES

(2)

AMENDED

BUDGET

(3)

EXPENDITURE

TO DATE

(4)

BUDGET

BALANCE

(5)

8. Salaries - Instructional

9. Salaries - Non-instructional

10. Employee Benefits

11. Travel

12. Supplies and Materials

13. Purch Services/Consultant Fees

14. Reimbursement $7,000

15. Printing and Reproduction

16. Utilities and Communications

17. Other ( )

18. SUBTOTAL $7,000

19. Indirect Cost ( % x line 18)

20. Capital Outlay

21 TOTAL $7,000

22. Administrative Costs

23. Cash Balance (For Completion Purposes)

* SEE INSTRUCTIONS ON NEXT PAGE

C. COMPLETION REPORT SIGNATURE (Blue Ink Only) I hereby certify that this is a reasonable statement of total expenditures for this Agreement.

Applicant Authorized Agent Date

D. SUMMARY OF AVAILABLE FUNDS INCLUDED IN BUDGET ABOVE

E. ESTIMATED NEEDS PAYMENT SCHEDULE (Original [ ] Revised [ ] Date ) FY State C/O FY FY Jul Jan

Aug Feb

Sept Mar

Oct Apr

Nov May

ADE FORM-701d (FEB 01) 6

Dec Jun

TOTAL

ADE FORM-701d (FEB 01)

INSTRUCTIONS FOR COMPLETING ADE FORM 701d, AGREEMENT BUDGET REPORT:

APPLICATION

Section A. AGREEMENTT IDENTIFICATION FOR THE BUDGET PERIOD

1. Enter the name of the agency applying for funds.

2. Enter the name and phone number of contact person 3-4. This area will be completed by ADE.

5. Enter date submitted to ADE.

6. Enter proposal name (if any).

7. Check appropriate place.

Section B. AGREEMENT BUDGET BY LINE ITEM 8-17. Enter budget amounts for each line item.

18. Enter budget subtotal.

19. Compute indirect costs. Each funding source has a limit on what per cent of the funds can be designated indirect costs. You will be unable to exceed that limit. You may choose to use more of the funds in the program and establish a smaller indirect cost than the limit.

20. Enter the capital outlay amount. (some Requests for Proposals may restrict capital outlay expenditures.)

21. Enter budget total.

Section C. PAYMENT SCHEDULE Recommend the payment amount for each month that you estimate you will need. Refer to your budget justification, capital outlay justification pages or other reference pages before completing. If a payment schedule is not indicated by the applicant, ADE will complete.

Final payment schedule will be determined by ADE.

Sections D and E: for ADE use only

ADE FORM-701b (FEB 01)

DETAILED INTERAGENCY SERVICE AGREEMENT BUDGET

(1) Applicant Name/Agency: (2) Agreement No.

(3)

EXPENDITURE

CATEGORY

NUMBER

(4)

AGREEMENT

BUDGET

LINE ITEM NAME

(5)

NAME AND TITLE OF STAFF

AND/OR

BREAKDOWN OF INDIVIDUAL ITEMS INCLUDED IN

AGREEMENT BUDGET LINE ITEM TOTAL

(6)

100% COST

OF EACH

ITEM LISTED

COLUMN (3)

(7)

ASSIGNED

TO THIS

(8)

COST

TOTAL:

INSTRUCTIONS FOR COMPLETION OF ADE FORM 701b, DETAILED EXPENDITURE BUDGETS

1) Enter the full name of applicant agency.

2) Enter agreement no.

3) From budget page, use expenditure category line number.

4) From budget page, use expenditure category name.

5) Briefly detail names/titles or other specifics that describe the proposed expenditures. If more than one item is included within the proposed expenditure for a line item, detail the costs within that line. See example below for sample of detail of line items.

6) Enter the actual 100% cost or actual 100% agency contracted salary amounts, even if a proposed salary or item cost is not in 100% support of the demonstration site.

7) Enter the appropriate % that would be assigned to this agreement.

8) In relation to column 6, how much funding are you requesting in this application?

EXAMPLE

(3)

EXPENDITURE

CATEGORY

NUMBER

(4)

BUDGET

LINE ITEM NAME

(5)

NAME AND TITLE OF STAFF

AND/OR

BREAKDOWN OF INDIVIDUAL ITEMS INCLUDED IN

AGREEMENT BUDGET LINE ITEM TOTAL

(6)

100% COST

OF EACH

ITEM LISTED

COLUMN (3)

(7)

ASSIGNED

TO THIS

(8)

COST

Salaries - Instructional

Salaries Non- Instructional

Benefits

Benefits

Other Expenses

Capital Outlay

Instructor

Counselor

Benefits for Instructor

Benefits for Counselor

Rent of Facilities

Computer and Monitor

$10,000

$20,000

$ 2,500

$ 5,000

$24,000

50%

100%

50%

25%

$20,000

$ 1,250

$ 6,000

$42,250

PLEASE NOTE: All capital expenditures with a useful life of one year or more and costing $1,000 or more must be reflected on form ADE FORM 640 (Capital Outlay Request).

25-44-ED Fredonia High School Final Audit Report 2025-12-10

Created: 2025-12-04

By: Desiree Lewis (Desiree.Lewis@azed.gov)

Status: Signed

Transaction ID: CBJCHBCAABAAaNDetP8rPynJMzG7W1gcU2ESmlzl0nMu

"25-44-ED Fredonia High School" History Document created by Desiree Lewis (Desiree.Lewis@azed.gov)

2025-12-04 - 8:34:57 PM GMT

Document emailed to Jay Arnold (Jay.Arnold@azed.gov) for signature

2025-12-04 - 8:35:53 PM GMT

Email viewed by Jay Arnold (Jay.Arnold@azed.gov)

2025-12-10 - 4:28:28 PM GMT

Document e-signed by Jay Arnold (Jay.Arnold@azed.gov) Signature Date: 2025-12-10 - 4:29:05 PM GMT - Time Source: server

Document emailed to Braulio Garcia (braulio.garcia@azed.gov) for signature

2025-12-10 - 4:29:07 PM GMT

Email viewed by Braulio Garcia (braulio.garcia@azed.gov)

2025-12-10 - 4:36:27 PM GMT

Document e-signed by Braulio Garcia (braulio.garcia@azed.gov) Signature Date: 2025-12-10 - 4:36:50 PM GMT - Time Source: server

Agreement completed.

2025-12-10 - 4:36:50 PM GMT