# Table 1 **Participants by Entering Educational Functioning Level, Ethnicity, and Sex** **Enter the number of participants* by educational functioning level,** ethnicity,*** and sex.**

**Entering Educational**  **Functioning Level American**  **Indian or Alaska Native**  **Asian Black or**  **African**   ** American** **Hispanic/**

**Latino Native** 

**Hawaiian or Other Pacific**  **Islander White**  **Two or more races**  **Total Male**  **Female Male**  **Female Male**  **Female Male**  **Female Male**  **Female Male**  **Female Male**  **Female (A)**  **(B) (C)**  **(D) (E)**  **(F) (G)**  **(H) (I)**  **(J) (K)**  **(L) (M)**  **(N) (O)**  **(P)** 

# ABE Beginning Literacy ABE Beginning Basic Education ABE Intermediate Low ABE Intermediate High ASE Low ASE High ESL Beginning Literacy ESL Low Beginning ESL High Beginning ESL Intermediate Low ESL Intermediate High ESL Advanced **Total** OMB Number 1830
- 0027, Expires 08/31/2014. *A participant is an adult who receives at least twelve (12) hours of instruction. Work
- based project learners are not included in this table. **See definitions for educational functioning levels. *** See definitions of race/ethnicity categories and examples that demonstrate how to report them. A participant should be i ncluded in the racial/ethnic group to which he or she appears to belong, identifies with, or is regarded in the community as belon ging. If a student does not self
- identify a race/ethnicity, the program must use observer identification.

# Table 2 **Participants by Age, Ethnicity, and Sex** **Enter the number of participants by age,* ethnicity,** and sex.**

**Age Group American Indian** 

**or Alaska Native**  **Asian Black or African**  **** **American Hispanic/** 

**Latino Native Hawaiian** 

**or Other Pacific Islander**  

# White **Two or more races**  **Total Male**  **Female Male**  **Female Male**  **Female Male**  **Female Male**  **Female Male**  **Female Male**  **Female (P)**  **(A) (**  **B) (C)**  **(D) (E)**  **(F) (G)**  **(H) (I)**  **(J) (K)**  **(L) (M)**  **(N) (O)**  

# 16

– 18 19

–24 25

–44 45

–59 60 and Older **Total** Work
- based project learners are not included in this table. *Pa rticipants should be classified based on their age at entry. However, p articipants entering the program prior to the current program year should be classified based on their age at the beginning o f the current program year. ** See definitions of race/e thnic categories and examples that demonstrate how to report them. The T otal row in Columns B

– O should equal the T otal row in Column s B

– O of Table 1. Row totals in Column P should equal the corresponding Total row in Table 3.

OMB Number 1830
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# Table 3 **Participants by Program Type and Age Enter the number of participants by program type and age.** 

**Program Type 16** **– 18**  **19 –** **24 25** **– 44**  **45 –**  **59 60 and Older**  **Total (A)**  **(B) (C)**  **(D) (E)**  **(F) (G)**  

# Adult Basic Education Adult Secondary Education English
- as - a - Second Language **Total** Work
- based project learners are not included in this table.
The T otal row in Colum n G should equal the T otal row in Column P of Table 1. OMB Number 1830
- 0027, Expires 08/31/2014.

# Table 4 **Educational Gains and Attendance by Educational Functioning Level Enter number of participants for each category listed, total attendance hours, and**  **calculate percentage of participants completing each level.**

**Entering Educational Functioning Level**  **Total Number Enrolled**  **Total**

**Attendance Hours**  **Number**

**Completed Level**  **Number W**  **ho**

**Completed a Level and**  **Advanced One or More Levels**  **Number**

**Separated Before**  **Completed Number** 

**Remaining Within Level**  **Percentage**

**Completing Level**  **(A) (B)**  **(C) (D)**  **(E) (F)**  **(G) (H)**  

# ABE Beginning Literacy ABE Beginning Basic Education ABE Intermediate Low ABE Intermediate High ASE Low ASE High* ESL Beginning Literacy ESL Low Beginning ESL High Beginning ESL Intermediate Low ESL Intermediate High ESL Advanced **Total** Work
- based project learners are not included in this table. The numbers in each row of Column B should equal the numbers in the corresponding rows of Column P of Table 1

. Column D is the total number of learners who completed a n educational functioning level, including learners who left after completing and learners who remained enrolled and moved to one or more higher levels. Column E represents a subset of Column D (Number Completed Level) and is learners who completed a level and enrolled in one o r m ore higher levels. Column F is students who left the program before completing a level. It also includes students who have not completed a level, received no services for 90 consecutive days , and have no scheduled services. Column D + F + G should equal t he total in Column B. Column G represents the number of learners still enrolled who are at the same educational level as when they entered

. Each row total in Column H is calculated by using the following formula: ColumnB ColumnD 

# H 

# *Completion of ASE Hi gh level is attainment of a secondary school credential or completing all components of a state

- recognized examination leading to a secondary credential or its equivalent

. OMB Number 1830

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# Table 4B **Educational Gains and Attend ance for Pre**  **- and**  **Post -** **tested Participants**  **Enter number of pre -**  **and post -** **tested participants for each category listed, calculate percentage of post -** **tested participants completing each level, and enter total attendance hours for post** **- tested completion.** 

**Entering Educational Functioning**

**Level Total Number**  **Enrolled Pre**  **- and Post** **** **tested Total** 

**Attendance Hours**  **Number**

**Completed Level**  **Number W**  **ho**

**Completed a Level and**  **Advanced One or More Levels**  **Number**

**Separated Before**  **Completed Number** 

**Remaining Within Level**  **Percentage**

**Completing Level**  **(A) (B)**  **(C) (D)**  **(E) (F)**  **(G) (H)**  

# ABE Beginning Literacy ABE Beginning Basic Education ABE Intermediate Low ABE Intermediate High ASE Low ASE High* ESL Beginning Literacy ESL Low Beginning ESL High Beginning ESL Intermediate Low ESL Intermediate High ESL Advanced **Total Include in this table only students who are both pre**  **- and post** **- tested.**  Work
- based project learners are not included in this table. Column D is the total number of learners who completed a level, including learners who left after completing and learners who remained enrolled and moved to one or more higher levels. Column E represents a subset of Column D (Numbe r Completed Level) and is learners who completed a level and enrolled in one or more higher levels. Column F is students who left the program before completing a level. It is also students who have not completed, received no services for 90 consecutive da ys , and have no scheduled services. Column D + F + G should equal the total in Column B. Column G represents the number of learners still enrolled who are at the same educational level as when they entered. Each row total in Column H is calculated using th e following formula: ColumnB ColumnD 

# H 

# *Completion of ASE high level is attainment of a secondary school credential or completing all components of a state
- recognized examination leading to a secondary credential or its equivalent

. OMB Number 1830
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# Table 4C **Educational Gains and Attendance for Participants in Distance Education Enter number of distance education participants for each category listed, calculate percentage of participants completing eac**  **h level, and enter total proxy and direct**  **attendance hours.**

**Entering Educational Functioning Level**  **Total Number Enrolled**  **In Distance Education**  **Total Estimated**

**and Actual Attendance**  **Hours Number** 

**Completed Level**  **Number W**  **ho**

**Completed a Level and**  **Advanced One or**  **More Levels Number** 

**Separated Before**  **Completed Number** 

**Remaining Within Level**  **Percentage**

**Completing Level**  **(A) (B)**  **(C) (D)**  **(E) (F)**  **(G) (H)**  

# ABE Beginning Literacy ABE Beginning Basic Education ABE Intermediate Low ABE Intermediate High ASE Low ASE High* ESL Beginning Literacy ESL Low Beginning ESL High Beginning ESL Intermediate Low ESL Intermediate High ESL Advanced **Total Include in this table only**  **students who are counted as distance education students.** Work
- based project learners are not included in this table. Column D is the total number of learners who completed a level, including learners who left after completing and learners who remained en rolled and moved to one or more higher levels. Column E represents a subset of Column D (Number Completed Level) and is learners who completed a level and enrolled in one o r more higher levels. Column F is students who left the program before completing a level. It is also students who have not completed, received no services for 90 consecutive days , and have no scheduled services. Column D + F + G should equal the total in Column B. Column G represents the number of learners still enrolled who are at the same educational level as when they entered.

# Each row total in Column H is calculated using the following formula: ColumnB ColumnD 

# H  *Completion of ASE high level is attainment of a secondary school credential or successful completion of all components of a state
- recognized examination leading to a secondary credential or its equivalent

. OMB Number 1830
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# Table 5 **Core Follow -**  **up Outcome Achievement**

**Core Follow -**  **up Outcome Measures**  **M**

**e t**  **h o**  **d Number of**  **Participants in Cohort**  **Number of**

**Participants Used for**  **Representative Cohort**  **Number of**

**Participants Responding**  **to Surve y or**  **Available for Data Matching**  **Response**

**Rate or Percent**  **Available for Match**  **Number of**

**Participants Achieving**  **Outcome (Unweighted)**  **Numb er of** 

**Participants Achieving**  **Outcome (Weighted)**  **Percent**

**Achieving Outcome**  **(Weighted) (A)**  **(B) (C)**  **(D) (E)**  **(F)** 

# (G) **(H )**  Entered Employment* U N/A

R C Retained Employment** U N/A

R C Obtained a Secondary School Credential or Its Equivalent*** U N/A

R C Entered Postsecondary Education or Training

– current program year  U N/A

R C Entered Postsecondary Education or Training

– prior program year** ** U N/A

R C U = Universe cohort; programs attempted to collect data for all eligible participants either by survey, data ma tch or both R = Representative cohort; programs attempted to collect data for a representative subset of eligible participants C = Combined universe and representative cohort totals; these numbers will be calculated au tomatically by OCTAE’s data system

# Instructions for Completing Table 5



# Note: All shaded columns (E, G, and H) and rows for cohort totals will be calculated automatically by O CTAE’ s data system. Work
- based project learners are not included in this table. 

# * Report in Column B the number of participants who were unemployed and in the labor force at entry who exited during the program year. Do not exclude students because of missing Social Security numbers or other missing data. ** Report in Column B: (1) the number of participants who were unemployed and in the labor force at entry who exited during the program year and who entered employment by the end of the first quarter after program exit and (2) the number of participants employed at entry who exited during the program year
**.** *** Report in Column B the number of participants who exited during the prog ram year and (1) took all components of a state
- recognized examination leading to a secondary credential or its equivalent or (2) were enrolled in adult high school at the high ASE level or (3) were enrolled in the assessment phase of the EDP.   Report in Column B the number of participants who exited during the program year and (1) have earned a secondary school credential or its equivalent while enrolled in adult education , or (2) have a secondary school credential at entry, or (3) are enrolled in a cl ass specifically designed for transitioning to community college. Enter the number of these participants who enrolled during the current program year in the row labeled “ current program year. ” Enter the number of these participants who enrolled during th e program year immediately prior to the current year in the row labeled “ prior program year. ” For Columns B through D and Column F, t he first row for each follow
- up outcome measure should be used to report information based on universe cohorts, and the sec ond row should be used to report information based on representative cohorts. If no program used representative cohorts, the “R” rows should be left blank. If no program used universe cohorts, the “U” row should be left blank. For programs using universe cohorts , Column E 

# ColumnB ColumnD
 

# . For programs using representative cohorts, Column E 

# ColumnC ColumnD
 

# . Column H is the number in Column G divided by the number in Column B. Column H should never be greater than 100 percent. If the response rate is less than 50 percent (Column E) for universe cohorts or less than 70 percent for representative cohorts, the data system will not return a valid percent in Column H.

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.

# Table 5A

** Core Follow****- up Outcome**  **Achievement for Participants in Distance Education**

**Core Follow -**  **up Outcome Measures**  **M**

**e t**  **h o**  **d Number of**  **Participants in Cohort**  **Number of**

**Participants Used for**  **Representative Cohort**  **Number of**

**Participants Responding**  **to Surve y or**  **Available for Data Matching**  **Re sponse** 

**Rate or Percent**  **Available for Match**  **Number of**

**Participants Achieving**  **Outcome (Unweighted)**  **Number of**

**Participants Achieving**  **Outcome (Weighted)**  **Percent**

**Achieving Outcome**  **(Weighted) (A)**  **(B) (C)**  **(D) (E)**  **(F)** 

# (G) **(H )**  Entered Employment* U N/A

R C Retained Employment** U N/A

R C Obtained a Secondary School Credential or Its Equivalent*** U N/A

R C Entered Postsecondary Education or Training

– current program year  U N/A

R C Entered Postsecondary Education or Training

– prior program year** ** U N/A

R C U = Universe cohort; programs attempted to collect data for all eligible participants either by survey, data ma tch or both R = Representative cohort; programs attempted to collect data for a representative subset of eligible participants C = Combined universe and representative cohort totals; these numbers will b e calculated automatically by OCTAE’s data system

# Instructions for **Completing Table 5A**

**Include in this table only students who are counted as distance education students. Follow the same instructions for Completing Table 5 to complete Table 5a, repeated below.**  

# Note: All shaded columns (E, G, and H) and rows for cohort totals will b e calculated automatically by OCTAE’s data system. Work
- based project learners are not included in this table. 

# * Report in Column B the number of participants who were unemployed and in the labor force at entry who exited during the program year. Do not exclude students because of missing Social Security numbers or other missing data. ** Report in Column B: (1) the number of participants who were unemployed and in the labor force at entry who exited during the program year and who entered em ployment by the end of the first quarter after program exit and (2) the number of participants employed at entry who exited during the program year
**.** *** Report in Column B the number of participants who exited during the program year and (1) took all compo nents of a state
- recognized examination leading to a secondary credential or its equivalent or (2) were enrolled in adult high school at the high ASE level or (3) were enrolled in the assessment phase of the EDP.   Report in Column B the number of participants who exited during the program year and (1) have earned a secondary school credential or its equivalent while enrolled in adult education , or (2) have a secondary credential at entry, or (3) are enrolled in a class specifically designed for tra nsitioning to community college. Enter the number of these participants who enrolled during the current program year in the row labeled current program year. Enter the number of these participants who enrolled during the program year immediately prior to the current year in the row labeled prior program year. For Columns B through D and Column F, t he first row for each follow
- up outcome measure should be used to report information based on universe cohorts, and the second row should be used to report info rmation based on representative cohorts. If no programs used representative cohorts, the “R” rows should be left blank.

. If no programs used universe cohorts, the “U” row should be left blank. Column E 

# ColumnB

ColumnD
 

# , for programs that used unive rse cohorts

. For programs using representative cohorts, Column E 

# ColumnC ColumnD
 

# . Column H is the number in Column G divided by the number in Column B. Column H should never be greater than 100 percent. If the response rate is less than 50 percen t (Column E) for universe cohorts or less than 70 percent for representative cohorts, the data system will not return a valid percent in Column H.

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# Table 6 ** Participant Status and Program Enrollment** **Enter the number of participants for each of the categories listed.** 

**Participant Status on Entry into the Program Number** 

**(A) (B)**  

# Disabled Employed Unemployed Not in the Labor Force On Public Assistance Living in Rural Area* **Highest Degree or Level of School Completed ** ******* **US Based Schooling**  **Non -**  **US Based**

**Schooling** No schooling Grades 1
- 5 Grades 6
- 8 Grades 9
- 12 (no diploma) High School Diploma or alternate credential GED Some college, no degree College or professional degree Unknown TOTAL (both US Based and Non
- US Based) **Program Type** ****** In Family Literacy Program In Workplace Literacy Program In Program for the Homeless In Program for Work
- based Project Learners **Institutional Programs** In Correctional Facility In Community Correctional Program

# In Other Institutional Setting

**Secondary Status Measures (Optional)** Low Income Displaced Homemaker Single Parent Dislocated Worker Learning Disabled Adult *Rural areas are places with less than 2,500 inhabitants and located outside urbanized areas.

** Participants counted here must be in a program specifically designed for that purpose.

*********** **Enter the highest level of schooling or degree attained for each student in US or non**  **- US**  **- based schooling. Provide**  **only one entry per student. The total number of students reported here must be the same as the**  **number reported in the Total row of**  **Column P, Table 1**  **.**

OMB Number 1830
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# Table 7 **Adult Education Personnel by Function and Job Status**

**Adult Education Personnel Unpaid Volunteers**  **Total Number of Part** **- time Personnel**  **Total Number of Full**  **- time Personnel**  **(A) (B)**  **(C) (D)**  

# Function ***** State
- level Adminis trative/ Supervisory/Ancillary Services Local
- level Administrative/ Supervisory/Ancillary Services Local Counselors Local Paraprofessionals Local Teachers **Teacher Experience In Adult Education**  ** Less than one year One to three years More than three years Total Teachers Reported **Teacher Post -**  **Secondary Education**  *** Bachelor’s Degree or Higher No Bachelor’s Degree Total Teachers Reported **Teacher Certification** **** No certification Adult Education Certificat ion K
- 12 Certification Special Education Certification TESOL Certification
* Enter an unduplicated count of personnel by function and job status. In Column B , count one time only each part
- time employee of the program administered under the Adult Education State Plan who was paid out of Federal, State, and/or local education funds. In Column C , count one time only each full
- time employee of the program administered under the Adult Education State Plan who was paid out of Federal, State, and/or local education funds.

# In Column D , report the number of volunteers (personnel who are not paid ) who served in the program administered under the

Adult Education State Plan. ** Report adult education experience for paid teachers only, not volunteers

. Report an unduplicated count of teachers. The tota l number of teachers for wh om experience is reported must equal the sum of the numbers reported in Columns B and C for the row labeled “Local Teachers .“ *** In the first row, report an unduplicated count of teachers who have earned a bachelor’s degree or higher. In the second row, report an unduplicated count of teachers who have not earned a bachelor’s degree. In both rows , report only paid teachers. The sum of t he two rows must equal the sum of numbers reported in Columns B and C for the row labeled “Local Teachers.”

*** * See definitions of the teacher certification categories that are relevant to report . Report certification s for paid teachers only, not volunteers. R eport all certifications that a teacher has. A duplicated count, i.e. m ultiple responses for a single teacher, is allowed. Report teachers who lack certification s in the “No Certification” category. OMB Number 183 0
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# Table 8 **Outcomes for Adults in Family Literacy Programs (Optional) Enter the number of participants in family literacy programs for each of the categories listed.** 

**Core Follow -**  **up Outcome Measures**  **M**

**e t**  **h o**  **d Number of**  **Participants in Cohort**  **Number of**

**Participants Used for**  **Representative Cohort**  **Number of**

**Participants Responding**  **to Survey or Available for**  **Data Matching Response** 

**Rate or Percent**  **Available for Match**  **Number of**

**Participants Achieving**  **Outcome (Unweighted)**  **Number of**

**Participants Achieving**  **Outcome (Weighted)**  **Percent**

**Achieving Outcome**  **(Weighted) (A)**  **(B) (C)**  **(D) (E)**  **(F)** 

# (G) **(H)** Completed Educational Functioning Level* U N/A Entered Employment U N/A

R C Retained Employment U N/A

R C Obtained a Secondary School Credential or Its Equivalent U N/A

R C Entered Postsecondary Education or Training

– current program year U N/A

R C Entered Postsecondary Education or Training

– prior program year U N/A

R C

# Increased Involvement in Children’s Education U N/A

R C Helped more frequently with school Increased contact with children’s teachers More involved in children’s school activities 

# Increased Involvement in Children’s Literacy Activities U N/A

R C Reading to children Visiting library Purchasing books or magazines 

# For reporting completion of Educational Functioning Level: * Report in Column B for this row all family literacy program participants who received 12 or more hours of service. Column F should include all participants reported in Column B who advanced one or more levels.



# Compute Column H for this row using the following formula: 

# ColumnB ColumnF H  **For reporting Follow -**  **up Measures:** Follow instructions for completing Table 5 to report these outcomes. However, include only family literacy program participants in Table 8. Achievement of one or more of the increased involvement in children’s education or children’s literacy activities measures sh ould be counted only once per participant . However, the specific outcome should be recorded in the subcategory and more than one outcome may be reported, so that the total for the three subcategories may be greater than the total reported for the overall categor y. For example, a participant who helped more frequently with schoolwork and increased contact with child’s teachers would be recorded in both categories but would be counted only once in the overall category of “increased involvement in children’s education.” OMB Number 1830
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# Table 9 **Outcomes for Adults in Workplace Literacy Programs (Optional) Enter the number of participants in workplace literacy programs for each of the categories listed.** 

**Core Follow -**  **up Outcome Measures**  **M**

**e t**  **h o**  **d Number of**  **Participants in**  **Cohort Number of** 

**Participants Used for**  **Representative Cohort**  **Number of**

**Participants Responding**  **to Survey or Available for**  **Data Matching Response** 

**Rate or Percent**  **Available for Match**  **Number of**

**Participants Achieving**  **Outcome (Unweighted)**  **Number of**

**Participants Achieving**  **Outcome (Weighted)**  **Percent**

**Achieving Outcome**  **(Weighted) (A)**  **(B) (C)**  **(D) (E)**  **(F)** 

# (G) **(H)** Completed an Educational Functioning Level* Entered Employment U N/A

R C Retained Employment U N/A

R C Obtained a Secondary School Credential or Its Equivalent U N/A

R C Entered Postsecondary Education or Training

– current program year U N/A

R C Entered Postsecondary Education or Training

– prior program year U N/A

R C

# For reporting completion of Educational Functioning Level:

* Report in Column B for this row all workplace literacy program participants who received 12 or more hours of service. Column F should include all participants reported in Column B who advanced one or more levels. Compute Column G for this row using the following formula: 

# ColumnB ColumnF G  **For reporting Follow -**  **up Measures:** Follow instructions for completing Table 5 to report the outcomes. However, include only workplace literacy program participants in Table 9.
OMB Number 1830
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# Table 10 **Outcomes for Adults in Correctional Education Programs Enter the number of participants in correctional**  **education programs for each of the categories listed.**

**Core Follow -**  **up Outcome Measures**  **M**

**e t**  **h o**  **d Number of**  **Participants in Cohort**  **Number of**

**Participants Used for**  **Representative Cohort**  **Number of**

**Participants Responding**  **to Survey or Available for**  **Data Matching Response** 

**Rate or Percent**  **Available for Match**  **Number of**

**Participants Achieving**  **Outcome (Unweighted)**  **Number of**

**Participants Achieving**  **Outcome (Weighted)**  **Percent**

**Achieving Outcome**  **(Weighted) (A)**  **(B) (C)**  **(D) (E)**  **(F)** 

# (G) **(H)** Completed an Educational Functioning Level* Entered Employment U N/A

R C Retained Employment U N/A

R C Obtained a Secondary School Credential or Its Equivalent U N/A

R C Entered Postsecondary Education or Training

– current program year U N/A

R C Entered Postsecondary Education or Training

– prior program year U N/A

R C

# For reporting completion of Educational Functioning Level:

* Report in Column B for this row all correctional educational program participants who received 12 or more hours of service. Column F should include all participants reported in Column B who advanced one or more levels. Compute Column G for this row us ing the following formula: 

# ColumnB ColumnF G  **For reporting Follow -**  **up Measures:** Follow instructions for completing Table 5 to report the outcomes. However, include only correctional educational program participants in Table 10.
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# Table 11 **Secondary Outcome Measures (Optional) Enter the number of participants for each of the categories listed.** 

**Secondary Outcome Measures** ***** **Number of Participants**  **Number of**

**Participants Obtaining**  **Outcome Percentage** 

**Achiev ing**  **Outcome (A)**  **(B) (C)**  **(D)** 

# Achieved Work
- Based Project Learning Goal Left Public Assistance Achieved Citizenship Skills Increased Involvement in Children’s Education* * Increased Involvement in Children’s Literacy Activities* Voted or Registered to Vote Increased Involvement in Community Activities Each row total In Column D is calculated using the following formula: 

# ColumnB ColumnC D  * See definitions of secondary outcome measures.

* * Enter the total number of participants who achieved this outcome regardless of whether the participant was in a family literacy program. Use Table 8 to enter achievements of family literacy participants. The number reported here may be higher than reported in Table 8 because it includes all participants who achieved this goal. OMB Number 1830
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# Table 12 (Optional) **Work -**  **based Project Learners by Age, Ethnicity, and Sex Enter the number of work** **-** **based project learners by age,* eth** **nicity, and sex.**

**Age Group American Indian** 

**or Alaska Native Asian**  **Black or African**  **** **American Hispanic/** 

**Latino Native** 

**Hawaiian or Other Pacific**  **Islander White**  **Two or more races**  **Total Male**  **Female Male**  **Female Male**  **Female Male**  **Female Male**  **Female Male**  **Female Male**  **Female (P)**  **(A) (B)**  **(C) (D)**  **(E) (F)**  **(G) (H)**  **(I) (J)**  **(K) (L)**  **(M) (N)**  **(O)** 

# 16

– 18 19

–24 25

–44 45

–59 60 and Older **Total** Only participants designated as work
- based project learners should be included in this table. These participants should not be included in Tables 1

– 5. The number in the T otal row of Column P should equal the number of work
- based project learners reported in Table 6. *Participants should be classified based on their age at entry. OMB Number 1830
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# Table 14 **Local Grantees by Funding Source Enter the number of each type of grantee (see attached definitions) directly funded by the state and the**  **amount of federal and stat e funding they receive.** 

**Provider Agency (A)**  **Total**

**Number of Providers**  **(B) Total** 

**Number of Sub**  **** **Recipients (C)**  **WIA Funding State Funding** 

**Total (D)**  **% of Total**

**(E) Total** 

**(F) % of Total** 

**(G)** Local Education Agencies **Public or Private Nonprofit Agency**  Community
- based Organizations Faith
- based Organizations Libraries **Institutions of Higher Education** Community, Junior or Technical Colleges Four
-year Colleges or Universities Other Institutions of Higher Education **Other Agencies** Correctional Institutions Other Institutions (non
- correctional) All Other Agencies **Total** 

# 1. In Column (B), report the number of providers receiving a grant award or contract for instructional services from the eli gible agency. 2. In Column (C), report the total number of each entity receiving funds as a sub
- recipient of providers in column B . (Entities receiving funds from a grantee as part of a consortium are reported in column (C).) 3. In Column (E), the percentage for each row is to be calculated using the following formula: Column D

---- --------------------- = Col (E) Total WIA Funding 4. In Column (F), report total amount of state funds contributed. This amount need not necessarily equal the non
- federal expenditure reported i n the F ederal Financial Report. 5. In Column (G), the percentage for each row is to be calculated using the follo wing formula : Colu mn F

----------------------- = Col (G) Total State Funding OMB Number 1830
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# Grantee Definitions for Table 14

**Local Education Agencies** are publicly funded entities designated to administer and provide primary and secondary education instruction and services within a city, county, school district, township or region. **Community -**  **based Organizations** (CBOs) are private nonprofit organization s of demonstrated effectiveness that are representative of a community or significant segment of a community. **Faith -**  **based Organizations** (FBO) are non
- profit organizations associated with a faith community or multiple faith ministries. **Libraries** are public state and community funded institutions that offer education and community services in addition to providing access to print, audio
-visual and technology resources. **Community, Junior or Technical Colleges** are public institutions of higher education that of fer associate’s degree and certificate programs but, with few exceptions, award no baccalaureate degrees. **Four Year Colleges or Universities** are a public or private non
- profit institution s of higher education that primarily offers baccalaureate degree pro grams. **Other Institution s**  **of Higher Education** include public or private non
- profit institution s that are not community, junior, or technical college s or four
- year college s or universit ies

. **Correctional Institutions** refer to state or federal penal instituti ons for criminal offenders. These include prisons, jails, and other correctional detention centers. **Other Institutions (Non -**  **Correctional)** are any medical or special institutions not designed for criminal offenders. **All Other Agencies** include other public (federal, state, local) agencies not listed in the categories above.

# Instructions **Narrative Report** These instructions provide descriptive information for the narrative items in the report. The maximum number of pages is 10. Use the following outline in preparing the narrative part of the Annual Performance Report: 1. Describe successful activities, programs, and projects supported with State Leadership funds and describe the extent to which these activities, programs, and projects were successful in implementing the goals of the State Plan.
2. Describe any

significant findings from the Eligible Agency's evaluation of the effectiveness of the adult education and literacy activities based on the core indicators of performance.
3. Describe how the Eligible Agency has supported the integration o f activities sponsored under Title II with other adult education, career development, and employment and training activities. Include a description of how the eligible agency is being represented on the Local Workforce Inves tment Boards, adult education’s involvement on the State Workforce Investment Board, the provision of core and other services through the One

- Stop system and an estimate of the Title II funds being used to support activities and services through the One

- Stop delivery system.
4. Describe successful activities and services supported with EL Civics funds, including the number of programs receiving EL Civics grants and an estimate of the number of adult learners served. (Only states receiving EL

- Civics funds should respond to question #4).

# INSTRUCTIONS **Federal Financial Report OMB Number 1830**  **- 0027**  U.S. Department of Education Office of Career, Technical, and Adult Education Adult Education and Family L iteracy Act of 1998 Basic Grants to States

—CFDA 084.002 **A separate Federal Financial Report (**  **FFR )**  **is to be submitted**  **for each Grant**  **Period reported in Block 8 of th**  **is form .** 

**FFR Box**  **Number Reporting Item**  **Instructions**

1 Federal Agency

and Organizational Element to Which Report is Submitted This block is preprinted.

2 Federal Grant or Other Id entifying Number Assigned b y Federal Agency Enter the PR/Award number as indicated in Block 2 of the

Grant Award Notification.
3 Recipient Organization Enter the name and complete address of the recipient organization including zip code. 4a DUNS Number Enter the recipient organization’s Data Universal Numbering System (DUNS) number or Central Contract Registry extended DUNS number. 4b EI

N Enter the recipient organization’s Employer Identification

Number (EIN).
5 Recipient Account Number or Identifying Number Enter the account number or any other identifying number

assigned b y the recipient to the award. This number is for the recipient’s use onl y and is not required b y the Federal agency . 6 Report Ty

pe Indicate whether this FFR is an initial or final report.

7 Basis of Accounting (Cash/Accrual) Specify whether a cash or accrual basis was used for recording transactions related to the award and for preparing this FFR. Accrual basis of accounting refers to the accounting method in which expenses are recorded when incurred. For cash basis accounting, expenses are recorded when they

are paid. 8 Project/Grant Period Enter the Budget Period described in Block 6 of the Grant Award Notification.

# 9 Reporting Period **:**

(Month, Day , Year) Enter the beginning and ending dates of the period in which

yo u are reporting the financial activity of the grant. A first ye ar report will cover the first 15 months of the grant period e.g., July 1, 201 3 through September 30, 201 4 . The final report will cover the entire 27 months that grantees have to obligate their funds , e.g., July 1, 201 2 through September 30, 201 4

. 10 Transactions: **In 10a through 10n,** enter cumulative amounts from the beginning to the end date s of the reporting period specified in line 9. 10a Cash Receipts Enter the cumulative amount of actual cash received from the Federal agency during the reporting period.

10b Cash Disbursements Enter the cumulative amount of Federal fund disbursements (such as cash or checks) during the reporting period. Disbursement s are the sum of actual cash disbursements for direct charges for goods and services, the amount of indirect expenses charged to the award , and the amount of cash advances and pay

ments made to subrecipients and contractors.

10c Cash On Hand ( l ine a minus l ine b ) Enter the amount of Line 10a minus Line 10b. This amount

represents immediate cash needs. If more than three business days of cash are on hand, the Federal agency may require an explanation on Line 12, Remarks, explaining why the drawdown was made prematurely or other reasons for the excess cash. 10d Total Federal Funds Authorized Enter the total Federal funds authorized during the reporting

period.

10e Federal Share of Expenditures Enter the amount of Federal fund expenditures during the

reporting period . For reports prepared on a cash basis, expenditures are the sum of cash disbursements for direct charges for property and services; the amount of indirect expense charged; and the amount of cash advance pay ments and pay ments made to subrecipients. For reports prepared on an accrual basis, expenditures are the sum of cash disbursements for direct charges for property and services; the amount of indirect expense incurred; and the net increase or decrease in the amounts owed by the recipient for (1) goods and other property received; (2) services performed b y employees, contractors, subrecipients, and other payees; and (3) programs for which no current services or performance are required.

# 10f Federal Share of

Unliquidated Obligations Enter the Federal portion of unliquidated obligations during

the reporting period

. Unliquidated obligations on a cash basis are obligations incurred, but not yet paid. On an accrual basis, they

are obligations in curred, but for which an expenditure has not yet been recorded. Those obligations include direct and indirect expenses incurred but not yet paid or charged to the award, including amounts due to subrecipients and contractors. On the final report, this lin e should be zero unless the awarding agency has provided other instructions. Do not include any amount in Line 10f that has been reported in Line 10e. Do not include any amount in Line 10f for a future commitment of funds (such as a long

- term contract) for which an obligation or expense has not been incurred. 10g Total Federal Share ( sum of l ine e and line f) Enter the sum of l ine 10e and line 10f.
10h Unobligated Balance of Federal Funds ( l ine d minus line g) Enter the amount of l ine 10d minus l ine 10g.

10i Total Recipient Share Required Enter the total required recipient share (i.e. the greater of

required match or maintenance of effort) for reporting period specified in line 9. The required recipient share should include all matching and cost sharing provided b y recipients and third

-party providers to meet the level required by the Federal agency

. 10j Recipient Share of Expenditures Enter the recipient share of actual cash disbursements or

outlays (less any

rebates, refunds, or other credits) including pay ments to subrecipients and contractors. This amount may include the value of allowable third party in

- kind contributions. Note: On the final report this line should be equal to or greater than the amount of Line 10i. 10k Remaining Recipient Share to be Provided ( l ine i minus l ine j) Enter the amount of l ine 10 i minus l ine 10 j. If recipient share in l ine 10 j is greater than the required match amount in l ine 10i, enter zero. 10l Total Program Income Earned Enter the amount of program income earned.
10m Program Income Expended Enter the amount of program income that was added to funds

committed to the total project costs and expended to further eligible project or program activities. 10n Unexpended Program In come ( l ine l minus line m) Enter the amount of l ine 10 l minus l ine 10 m. This amount

equals the program income that has been earned but not expended as of the reporting period end date. 11 Indirect Expense: **In 11a through 11g** , enter cumulative amounts from the beginning through the end date of the reporting period.

# 11a Ty pe of Rate Indicate whether indirect cost rate is Restricted Provisional or

Restricted Final. 11b Rate Enter the indirect cost rate in effect during the reporting period. 11c Period From; Period To Enter the beginning and ending effective dates for the rate. 11d Base Enter the amount of the base against which the rate was applied. 11e Amount Charged Enter the amount of indirect costs charged during the time period specified. (Multiply 11b. x 11d.) 11f Federal Share Enter the Federal share of the amount in 11e. 11g Totals Enter the totals for columns 11d, 11e, and 11f. 12 Remarks Enter any explanations or additional information required by the Federal sponsoring agency including excess cash as stated in line 10c. 13a Ty

ped or Printed Name and Title of Authorized Certifying Official Enter the name and title of the autho rized certifying official.
13b Signature of Authorized Certifying Official The authorized certifying official must sign here. 13c Telephone (Area Code, number and e xtension) Enter the telephone number (including area code and extension)

of the individual listed in l ine 13a. 13d E
- mail Address Enter the e

- mail address of the individual listed in l ine 13a. 13e Date Report Submitted (Month, Day , Year) Enter the date the FFR is submitted to the U.S. Department of

Education using the month, day, year format. 14 Agency

Use Only This section is reserved for U.S. Department of Education use. **Federal Financial Reports are due on December 31 of each year. Reports must be submitted electronically via the online NRS reporting system.** 

# F **E D**  **E R** **A L**  **F I**  **N A** **NC I**  **A L**  

# R **EP O**  **RT**

**TOT A** **L A** **LLO C**  **A**

**TI ON**  1

. Fede ra l Ag e n cy a n d O rg a n i za t i o n a l E l e m e n t t o W h i c h Repo rt i s S u b m i tted

**U .**  **S**
**. D**  **epa rt**  **m en**  **t o** **f Educa**  **ti o**  **n D**  **i v**  **i s**  **i o**  **n o**  **f A** **du l**  **t Educa**  **ti o**  **n an**  **d L**  **it e**  **r acy**  2

. F edera l G ran t o r Ot he r I den t ifyi n g N u mbe r Ass i gne d b y F edera l Agency O M B A pp ro v a l Nu m be r: 1830
- 0027 Ex p i ra t i o n Da t e : 8 / 31 / 2014
3

. Re c i p i en t O rgan i z a t i o n ( Na me an d c o m p l e te add re ss i n c l ud i n g Z i p c ode) 4a

. DUN S Nu m ber 4b

. E I N 5

. Re c i p i en t Acc oun t Nu m be r o r I den t ifyi n g Nu m be r 6

. Repo rt Ty pe In i t i a l F in a l 7

. B a s i s of Acc oun t i n g C a sh Acc r u a l 8

. Proj e ct/G ran t P e r i o d ( M on t h , Da y , Y ea r) 9

. Repo r t i n g P e r i o d ( M on t h , Da y , Yea r) F ro m: T o : F ro m: T o: 10

. **T ra**  **n sac**  **t ion**  **s (**  **a )**  **St a**  **te A**  **d m**  **ini s**  **t ra**  **t io**  **n (**  **b )**  **St a**  **te L**  **ea d**  **ers hi**  **p (**  **c )**  **P r** **og ram**  **s o**  **f In**  **s t**  **r u**  **c t**  **io n**  **( 0**  **- 8**  **) (**  **d )**  **P r** **og ram**  **s o**  **f In**  **s t**  **r u**  **c t**  **ion (**  **9 -**  **12 )**  **( e**  **) In**  **s t**  **i t**  **u t**  **ion a**  **li z**  **e d**  **P ers**  **ons (f)**  **T o**  **t a**  **l**

**F e**  **d era**  **l Cas**  **h :**  a
. Ca sh Re c e i p ts b

. Ca sh D i s bu rs e m en t s c. Ca sh o n Han d ( li n e a m i nu s line b) **F e**  **d era**  **l E**  **x p**  **e ndi**  **t u**  **re s**  **a n**  **d U**  **noblig a**  **t e**  **d Ba**  **l a**  **n ce:**  d

. To t a l F ede ra l fund s au t ho r i z ed
e
. F ede ra l s ha re of e x pend i t u r e s f

. F ede ra l s ha re of un li qu i da t e d ob li ga t i ons g
. To t a l F ede ra l s ha re (s u m of li ne e an d line f ) h

. Unob li ga t e d ba l an ce of F ede ra l fund s ( li n e d m i nu s line g) **Rec ipi**  **e n**  **t S**  **h are:**  i

. To t a l re c i p i en t s ha re requ i re d ( i

. e
. M a i n t enan ce o f E ffo rt ) j

. Re c i p i en t s ha re of e x pend i t u r e s k. Re m a i n i n g re c i p i en t s ha re to b e p ro v i de d ( li n e i m i nu s line j ) **P r** **og ra**  **m In**  **c o**  **me:** l

. To t a l p rog ra m i n c o me ea r ned
m. Prog ra m i n c o me e x pended
n
. Une x pende d p rog ra m i n c o me ( li n e l m i nu s li n e m ) 11. I nd i r e ct Ex pen se a
. Ty p e

Re st r i cte d Prov i s i o na l Re st ricte d F in a l b

. Ra te c. P e r i o d F ro m P e r i o d To d

. B a se e
. Am oun t Cha rged f

. F ede ra l S ha re

g
. To t a l s: 12

. Re marks : A ttach any ex plana t i on s dee m e d necessar y o r i n f or ma t i o n re qui r e d by Federa l sponsor i n g agenc

y i n co m pl i anc e w i t h go v e r n i n g leg i s la tion: **13 .**  **Cer t**  **i f** **i ca**  **t ion**  **: B**  **y s**  **ignin g**  **t hi**  **s re**  **po r** **t, I**  **cer t**  **i fy**  **to t**  **h e**  **b es**  **t o**  **f m**  **y k**  **no w**  **l e**  **dg e**  **a n**  **d b**  **e li**  **e f**  **t h**  **a t**  **t h**  **e re**  **po r** **t i**  **s t**  **r u**  **e ,**  **c o**  **m pl**  **e t** **e ,**  **a n**  **d acc**  **u ra**  **t e**  **, a**  **n d**  **t h**  **e ex**  **p e**  **ndi t**  **u res**  **, di**  **s bu**  **rseme n**  **ts a**  **n d**  **cas h**  **rece ip**  **ts ar** **e f** **o r**  **t h**  **e pu**  **r po**  **se s**  **a n**  **d in**  **t e**  **n t**  **se t**  **f o**  **r th**  **i n**  **t h**  **e a**  **w ar** **d do**  **c u**  **me n**  **t s**  **. I**  **am a**  **w ar** **e t**  **h a**  **t a**  **n y**  **f a**  **l se**  **, f** **i c**  **t i**  **t iou**  **s ,**  **o r**  **f ra**  **udul e**  **n t**  **in f** **o rma**  **t io**  **n ma**  **y s**  **ubj ec**  **t m**  **e to**  **cr i**  **m in**  **a l**  **, c**  **i v**  **il ,**  **o r**  **a d**  **m ini**  **s t**  **ra t**  **i v** **e p**  **e n**  **a l**  **t i**  **es .**  **( U**  **. S.**  **C od**  **e ,**  **T i**  **t l**  **e 18**  **, S**  **ec t**  **io n**  **1001)** a
. Ty pe d o r Pr i n t e d Na me an d T i t l e of A u t ho r i z e d Ce r t ifyi n g Off i c i al c
. Te l ephon e (Are a code , number , an d ext ens i on) d

. Em a i l A dd r e ss b

. S i gna t u re of A u t ho r i z e d Ce r t ifyi n g Off i c i al e
. Da te Repo rt S ub m i tte d ( M on t h , Da y , Yea r) 14

. A gen cy u se on ly :

# Financial Reporting Requirements for EL **- Civics Funding** 

States expending EL

- Civics funds under the conditions 

# outlined in Program Memorandum 2000

– 19, issued by Ronald S. Pugsley on May 16, 2000, shall report those expenditures as follows: In addition to submitting an annual FFR that report s all Federal and non

- Federal expenditures, including those for EL

- Civics, states must submit, on an annual basis, a separate FFR for EL

- Civics expenditures. This EL

- Civics FFR, which represents a sub set of the overall FFR report, will provide the necessary information to determine whether EL
- Civics expenditures are in compliance with existing statutory requirements.

# F **E D**  **E R** **A L**  **F I**  **N A** **NC I**  **A L**  

# R **EP O**  **RT EL / Civics**  1

. Fede ra l Ag e n cy a n d O rg a n i za t i o n a l E l e m e n t t o W h i c h Repo rt i s S u b m i tted

**U .**  **S**
**. D**  **epa rt**  **m en**  **t o** **f Educa**  **ti o**  **n D**  **i v**  **i s**  **i o**  **n o**  **f A** **du l**  **t Educa**  **ti o**  **n an**  **d L**  **it e**  **r acy**  2

. F edera l G ran t o r Ot he r I den t ifyi n g N u mbe r Ass i gne d b y F edera l Agency O M B A pp ro v a l Nu m be r: 1830
- 0027 Ex p i ra t i o n Da t e : 8 / 31 / 2014 3

. Re c i p i en t O rgan i z a t i o n ( Na me an d c o m p l e te add re ss i n c l ud i n g Z i p c ode) 4a

. DUN S Nu m ber 4b

. E I N 5

. Re c i p i en t Acc oun t Nu m be r o r I den t ifyi n g Nu m be r 6

. Repo rt Ty pe In i t i a l F in a l 7

. B a s i s of Acc oun t i n g C a sh Acc r u a l 8

. Proj e ct/G ran t P e r i o d ( M on t h , Da y , Y ea r) 9

. Repo r t i n g P e r i o d ( M on t h , Da y , Y ea r) F ro m: T o : F ro m: T o: 10

. **T ra**  **n sac**  **t ion**  **s (**  **a )**  **St a**  **te A**  **d m**  **ini s**  **t ra**  **t io**  **n (**  **b )**  **St a**  **te L**  **ea d**  **ers hi**  **p (**  **c )**  **P r** **og ram**  **s o**  **f In**  **s t**  **r u**  **c t**  **io n**  **( 0**  **- 8**  **) (**  **d )**  **P r** **og ram**  **s o**  **f In**  **s t**  **r u**  **c t**  **ion (**  **9 -**  **12 )**  **( e**  **) In**  **s t**  **i t**  **u t**  **ion a**  **li z**  **e d**  **P ers**  **ons (f)**  **T o**  **t a**  **l F**  **e d**  **era l**  **Cas h**  **:** a
. Ca sh Re c e i p ts b

. Ca sh D i s bu rs e m en t s c. Ca sh o n Han d ( li n e a m i nu s line b) **F e**  **d era**  **l E**  **x p**  **e ndi**  **t u**  **re s**  **a n**  **d U**  **noblig a**  **t e**  **d Ba**  **l a**  **n ce:**  d

. To t a l F ede ra l fund s au t ho r i z ed
e
. F ede ra l s ha re of e x pend i t u r e s f

. F ede ra l s ha re of un li qu i da t e d ob li ga t i ons g
. To t a l F ede ra l s ha re (s u m of li ne e an d line f ) h

. Unob li ga t e d ba l an ce of F ede ra l fund s ( li n e d m i nu s line g) **Rec ipi**  **e n**  **t S**  **h are:**  i

. To t a l re c i p i en t s ha re requ i re d ( i

. e
. M a i n t enan ce o f E ffo rt ) j

. Re c i p i en t s ha re of e x pend i t u r e s k. Re m a i n i n g re c i p i en t s ha re to b e p ro v i de d ( li n e i m i nu s line j ) **P r** **og ra**  **m In**  **c o**  **me:** l

. To t a l p rog ra m i n c o me ea r ned
m. Prog ra m i n c o me e x pended
n
. Une x pende d p rog ra m i n c o me ( li n e l m i nu s li n e m ) 11. I nd i r e ct Ex pen se a
. Ty p e

Re st r i cte d Prov i s i o na l Re st ricte d F in a l b

. Ra te c. P e r i o d F ro m P e r i o d To d

. B a se e
. Am oun t Cha rged f

. F ede ra l S ha re

g
. To t a l s: 12

. Re marks : A ttach any ex plana t i on s dee m e d necessar y o r i n f or ma t i o n re qui r e d by Federa l sponsor i n g agenc

y i n co m pl i anc e w i t h go v e r n i n g leg i s la tion: **13 .**  **Cer t**  **i f** **i ca**  **t ion**  **: B**  **y s**  **ignin g**  **t hi**  **s re**  **po r** **t, I**  **cer t**  **i fy**  **to t**  **h e**  **b es**  **t o**  **f m**  **y k**  **no w**  **l e**  **dg e**  **a n**  **d b**  **e li**  **e f**  **t h**  **a t**  **t h**  **e re**  **po r** **t i**  **s t**  **r u**  **e ,**  **c o**  **m pl**  **e t** **e ,**  **a n**  **d acc**  **u ra**  **t e**  **, a**  **n d**  **t h**  **e ex**  **p e**  **ndi t**  **u res**  **, di**  **s bu**  **rseme n**  **ts a**  **n d**  **cas h**  **rece ip**  **ts ar** **e f** **o r**  **t h**  **e pu**  **r po**  **se s**  **a n**  **d in**  **t e**  **n t**  **se t**  **f o**  **r th**  **i n**  **t h**  **e a**  **w ar** **d do**  **c u**  **me n**  **t s**  **. I**  **am a**  **w ar** **e t**  **h a**  **t a**  **n y**  **f a**  **l se**  **, f** **i c**  **t i**  **t iou**  **s ,**  **o r**  **f ra**  **udul e**  **n t**  **in f** **o rma**  **t io**  **n ma**  **y s**  **ubj ec**  **t m**  **e to**  **cr i**  **m in**  **a l**  **, c**  **i v**  **il ,**  **o r**  **a d**  **m ini**  **s t**  **ra t**  **i v** **e p**  **e n**  **a l**  **t i**  **es .**  **( U**  **. S.**  **C od**  **e ,**  **T i**  **t l**  **e 18**  **, S**  **ec t**  **io n**  **1001)** a
. Ty pe d o r Pr i n t e d Na me an d T i t l e of A u t ho r i z e d Ce r t ifyi n g Off i c i al c
. Te l ephon e (Are a code , number , an d ext ens i on) d

. Em a i l A dd r e ss b

. S i gna t u re of A u t ho r i z e d Ce r t ifyi n g Off i c i al e
. Da te Repo rt S ub m i tte d ( M on t h , Da y , Yea r) 14

. A gen cy u se on ly :