1 **OMB Approval No.: 1840** **- New**  **Expiration Date: XX/XX/XXXX**  

## Educational Opportunity Centers (EOC **) Program Form for Annual Performance Report**  **for Program Year 2011 -**  **12 Section I: Project Identification, Certification and Warning**  **A. Project Ide**  **ntification** 1. PR/Award Number [pre-populated] : ________________________________________________ 2. Name of Grantee [pre -populated

___________________________________________________ 3. Address (City, State, Zip) [pre -populated] : _____________________
_______________________ 4. Name of Project Director [pre -populated] : __________________________________________ 5. Phone Number [pre-populated] : ________________ Fax Number [pre -populated] :___________ E - mail Address [pre-populated] :________________
________________ 6. Report Period [pre -populated] : ______________________ to ____________________________ MM/DD/YYYY MM/DD/YYYY 7. Name of Data Entry Person: ________________________________

_______________________ Phone Number:______________________ E - mail Address: ______________________________ **B. Certification:**  We certify that the performance report information reported a nd submitted electronically on _________ is readily verifiable. The information reported is accurate and complete to the best of our knowledge.

__________________________________ ___________________________________ Name of Project Director (Print) Name of Certifying Official (Print)

_______________________ ___________ ___________________________________ Signature and Date Signature and Date **C. Warning:**  Any person who knowingly makes a false statement or misrepresentation on this report is subject to penalties which may include fines, imprisonment, or both, under the United States Criminal Code and 20 U.S. C. 1097 . Further Federal funds or other benefits may be withheld under this program unless this report is completed and filed as required by existing law (20 U.S.C. 1231a) and regulations (34 CFR 75.591 and 75.720)2

**Authority: Public Law 102 -** **325, as amended.** According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless su ch collection displays a valid OMB control number. P ublic repo rting burden for this collection of information is estimated to average 8 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and co mpleting and reviewing the collection of information. T he obligation to respond to this collection is required to obtain or retain benefit (Education General Administrative Regulations, 34 CFR 75.591 and 75.720; program regulations, 34 CFR Part 644 and Title IV, Section 402A and 402F of High er Education Act of 1965, as amended (Public Law 102 - 325). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Avenue, S.W., Washington, DC 20202 -4536 or e- mail hICDocketMgr@ed.gov and reference the OMB Control Number 1840 -0561. N ote: P lease do not return the completed annual performance report to this address.3

**S ect**  **ion II: D**  **emographic Profile of Project Participants and Listing of Target schools NUMBER**  **P articipants Funded to serve**  **[ pre** **- populated** **] ____**  **____ A**  . **Types of Participants Assisted** 1. New participants

__ _____ 2. Continuing participants

_______ 3. Total participants

_______ **B. Participant Distribution by Eligibility**  1. Low- income and potential first -generation college students

_______ 2. Low- income only

_______ 3. Potential first -gen eration college students only

_______ 4. Other

_______ 5. Total (must equal A3)

_______ **C. Participant Distribution by Race and Ethnicity**  1. American Indian or Alaska Native, non - Hispanic/Latino 2. Hispanic/ Latino of any race _______ 3. Asian, non - Hispanic/Latino

_______ 4. Black or African American, non - Hispanic/Latino 5. White, non - Hispanic/Latino _______ 6. Native Hawaiian or Other Pacific Islander, non - Hispanic/Latino 7. Two or more races, non - Hispanic/Latino 8. Race or Ethnicity Unknown 9. Total (must equal A3) _______

_______

_______
**D. Participant Distribution by Gender**  1. Male

_______ 2. Female

_______ 3. Total (must equal A3)

_______ **E. Participant Distribution by Age (age of participants at time of**  **first service in budget period)** 1. 10 - 13

_______ 2. 14 - 18

_______ 3. 19 - 27

_______ 4. 28 and above

_______ 5. Unknown

_______ 6. Total (should equal A3)

_______4

**F. Veterans**  **served**
**________ G. Military connected students**  **(if applicable)** 1. Active duty military
**________** 1 . Spouse of active duty military

________ 2 . Child of active duty military

________ 3 . Total

________ **H . Participants with Limited English Proficiency**  (see 34 CFR 644.4(k)

________ **I . EOC**  **p articipants**  **also served during the reporting year by another federally f** **unded program (see 34**  **CFR 644.**  **32(c)(4))**
**________** 1. Upward Bound (UB)

________ 2. Upward Bound (UBMS)

________ 3. Veterans Upward Bound (VUB)

________ 4. Talent Search (TS)

________ 5. GEAR UP

________ 6. Other

________ 7. Served by more than one other federally funded program

________ **J .**  **TARGET SCHOOLS (if applicable)**  Please list all the target schools served during this budget period. For each target school, include the school’s identification number listed in the Common Core of Data (CCD) of the National Center for Education Statistics (NCES), the name of the school, its city, state, zip code, and the number of participants served duri ng the reporting period. A Web link to the CCD data will appear on the Web application to assist you in finding the NCES school identification numbers for your target schools. This section will be pre - populated for projects that had grants in 2010 - 11. P lease enter the requested information for each of the target schools served by the project and/or update or correct the data in the pre - populated list of target schools. Also, please check pre - populated NCES identification numbers for accuracy. NCES Scho ol ID # School name City State Zip Code Number

served5

**K . INVITATIONAL PRIORITIES (if applicable)**  Indicate whether your project addressed the following invitational priorities. 1. The Secretary encourages applicants to work with appropriate State agencies to use data from State longitudinal data systems or to obtain data from reliable third - party sources when providing information on the implementation of their EOC projects and their participants’ outcomes. 1A. No t a pplicable 1B. Yes If “Yes” , indicate below which data systems your project utilized. **State longitudinal data systems Third**  **- party**  **data systems**

2. The Secretary encourages applicants to coordinate project services with school - level partn ers and other community resources in order to carry out projects that are cost- effective and best meet the needs of adult learners, including veterans. 2A . Not applicable 2B . Yes If “Yes”, indicate below which community organizations, and partners you r project coordinated and collaborated.

**Community Organizations School**  **- level**  **Partners**6

**SECTION III: E ducational Status of EOC Participants (at the time of first service**  **in the reporting year A.**  **Educational Status of P roject Participants Aged 19 or Older**  **( at time of first**  **service in the budget period )**  **NUMBER** 1. Adult without any secondary school credentials, enrolled in an alternative education program at an academic level equivalent to that of a high school senior _______ 2. Adult without a ny secondary school credentials, and not enrolled in an alternative education program. _______ 3 . High school graduates or high school equivalency graduates not already enrolled in a postsecondary school _______ 4 . Postseco ndary dropout with a secondary school diploma or credentials

_______ 5 . Postsecondary dropout without a secondary school diploma or credential

_______ 6 . P ostsecondary transfer 7 . Postsecondary student _______ 8 . Unknown

_______

_______ 9 . Total

_______ **B. Educational Status of Secondary (Middle and High) School**  **- Age Students**  **( at**  **time of first service in the budget period) NUMBER**  1. Middle school (6 th
- 8 th grade) 2. High school non - senior (9th – 11th grade) _______ 3. High school senior or in alternative education program (12th grade only)

_______ 4. Secondary school dropout (not older than 18 years) 5 . Other participants not older than 18 years

_______

_______ 6 . Total

_______ **S ection**  **IV: Educational Status of EOC Participan** **ts (at end of**  **reporting period or for**  **the following fall**  **)** In this section all the standard objectives are listed for your EOC project. The percentage for each of these standard objectives will be pre - populated in the online Web application for all grante es. The pre populated numbers are based on the information provided on the Program Profile sheet submitted with your approved FY 2011 application. No changes may be made to these percentages on this form . However, if any of the pre - popu lated numbers refl ects a data entry error, you must contact your assigned program specialist to resolve the problem. So as to allow the Department to report aggregated data gathered in a uniform manner, all EOC grantees must report outcomes based on the standard objective s identified in the FY 2011 application. To better facilitate data collection, please enter a positive numeric value in each field. For fields not applicable to your project, please enter zero (0) . If more than one response is possible for a given parti cipant, choose the most recent status. Also, p lease refer to the “Definitions that Apply” section in7

the APR instructions for additional information on commonly used terms, e.g., secondary school diploma, and alternative education program , etc., that are new in this APR. **A. OBJECTIVE:**  **Secondary School Diploma**  _____% of participants served during the project year that did not have a secondary school diploma or its equivalent at the time of first service in the project year will receive a secondary schoo l diploma or its equivalent during the project year. **Educational Status of Such Participants NUMBER**  A1. Received a secondary school diploma or its equivalent A2. E nrolled in an alternative program but did not complete A3. N ot enrolled in an alternative program. A4. Deceased A5 . Unknown A 6 . Total The **denominator** is the number of participants, at time of first service in the reporting period, who were high school seniors or in an alternative program (sum of Section III A 1 , A2, B2, B3 , and B4 ) minus the deceased . The **numerator** is the number of participants who received a secondary school diploma or equivalent during the project year (Section I V A1 ). **B. OBJECTIVE: Financial Aid Applications**  _____% of participants served during the project year who at time of first service in the project year were not already enrolled in a postsecondary education program and who: 1) were high school seniors or equivalents in alternative education programs; 2) were high school graduates; o r 3) had obtained a high school equivalency certificate will apply for financial aid during the project year. **Financial Aid Completion NUMBER**  B1. Completed a financial aid application

__________ B2. D id not complet e a financial aid application

__________ B 3 . Unknown

__________ B 4 . Total

__________8

The **denominator** is the number of participants, at the time first service in the reporting period, who received a secondary diploma or equivalent (Section III, A1 , A3, A4, A 6, and B3 ) The **nume rator**  is the number of participants who applied for financ ial aid during the project year (Section IV, B1 ) . **C. OBJECTIVE :**  **Postsecondary Education Admissions** ____% of participants served during the project year who at time of first service in the project year were not already enrolled in a postsecondary education program and who: 1) were high school seniors or equivalents in alternative education programs; 2) were high school graduates; or 3) had obtained a high school equivalency certificate will apply for postsecondary admissions during the project year. **Postsecondary Education Admissions NUMBER**  C1. Applied for admission to a postsecondary education program
________ C2. Did not apply for admission to a postsecondary education program

________ C 3 . Unknown

________ C4 . Total

________ The **denominator** is the number of participants, at the first time of service in the reporting period, which received a secondary school diploma or equivalent and applied for financial aid (Section III , A1 , A3, A4, A 6 , and B3) The **numerator** is the number of participants, at the first time of service in the reporting period, who applied for admission to postsecondary education programs (Section I V, C 1) **D. OBJECTIVE: Postsecondary Education Enrollment**  ____% of seco ndary school graduates (or equivalents) who were served during the project year, and who were not already enrolled in a postsecondary education school at time of first service in the project year, will enroll in a postsecondary education program during the project year (or by the end of the next fall term), or will have received notification by the fall term of acceptance but deferred enrollment until the next academic term (e.g., spring term). **Postsecondary Education Status of Participants NUMBER**  D1. E nrolled in a postsecondary education program (first time enrollment or reentry) _______ D2. Did not enroll in a postsecondary education program
_______ D3. Deceased

_______ D 4 . Unknown

_______ D 5 . Total

_______ Please indicate which interpretat ion of the objectives wording was followed when the project established the objective rate for postsecondary enrollment.9

The denominator for this objective would include participants that received a secondary school diploma or its equivalent during t he reporting year (Section IV A1), **or** The denominator for this objective would include participants that received a secondary school diploma or its equivalent during the reporting year (Section IV A1) and those participants who ha d a secondary schoo l diploma or credentials at the time of first service (Section III A3 , A4, and A 6 ) during the reporting year. The **numerator** is the numb er of project participants, served during the project year, enrolled in a postsecondary education program (Section IV, D1 ). **Note: Once an interpretation has been selected in the 2011**  **- 12 APR, it cannot be changed for the**  **remainder of the current grant cycle to maintain consistent PE calculations across all PE assessment years**  . **E .**  **Postsecondary Placements (** **Types of Institutions**  **)** Please indicate the number of participants enrolled in postsecondary education for each type of postsecondary institution listed **T YPE AND**  **C ONTROL OF**  **P OSTSECONDARY**  **I NSTITUTIONS**  **N UMBER**  E1. Public, two -year institution

________ E2. Privat e, non - profit, two -year institution

________ E3. Public, four-year institution

________ E4. Private, non - profit, four-year institution

________ E5. Public or non - profit vocational/technical institution

________ E6. Proprietary school

________ E7. Unknown

________ E8. Total (should equal IV, D1)

________