# Charter Schools Program (CSP) **Office of Innovation and Improvement U.S. Department of Education**  **CSP Data Collection Form - Replication and Expansion (R&E) for High-Quality Charter Schools Grantees**

Part Basks for CSP school award information. In all, grantees will provide the following information for each school receiving CSP funds: 1) the name and contact information for the charter school and LEA; 2) the authorized public chartering agency; 3) the total amount of funding an applicant received to replicate or expand a charter school, along with the beginning and end date of when funds were received; 4) the grades served and number of available seats per school; and 5) other charter school information (e.g., enrollment) as needed.



# Instructions

**Purpose of Data Collection:** The new data collection will collect grant award information from grantees funded under the **Replication and Expansion for High-Quality**  **Charter Schools**competition. The CSP Data Collection Form will allow the U.S Department of Education (ED) to monitor CSP grant performance and analyze data related to accountability for academic performance and financial integrity. It will also allow the CSP to track the number of schools receiving financial support under this competition. The data collection will assist in carrying out the purpose of the Charter School Program Section 5201 of the ESEA, which is to expand the number of high quality charter schools and increase the national understanding of the charter school model.

Part A asks for CSP grantee award information. The name, the contact person, and the contact person's department has already been entered in the form. If this information is incorrect, please contact the data collection administrators (see "Contact Information" below). In the gray boxes, please enter the number of schools for each Federal Fiscal Year that are still receiving CSP funds within the grantee's project period. Keep in mind that your Grant Award Notification (GAN) provides the beginning and end date for your current project period. **For Grantees:** The CSP Data Collection Form has two parts:

**OMB Number: 1855-0016 Approval Expires 2/28/2015** 

# Form Submission:

4665 Lampson Ave. Los Alamitos, CA 90720 Please be sure to make a copy of the completed form for your own records.

**Paperwork Burden Statement:** According to the Paperwork reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1855-0016. The time required to complete this information collection is estimated to average 127 hours per response, including the time to review instructions, search existing data resources, gather the data needed and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4537. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: U.S. Department of Education, Office of Innovation and Improvement 400 Maryland Avenue, S.W ., LBJ4W227, Washington D.C. 20202-2800. **Contact Information:** If you have any questions or concerns regarding the completion of the CSP Data Collection Form, please contact WestEd. You can email us at **CSPdatacollection@Wested.org** , or call toll-free **866-902- 4887** 

. Attn: CSP Data Collection WestEd If an electronic copy cannot be sent, please send a paper copy of the completed CSP Data Collection Form to the following address: The completed CSP Data Collection Form should be sent to **CSPdatacollection@wested.org** . In the subject heading please include "CSP Data Collection" followed by your organization's name. Please be sure to save a copy of the completed form for your own records.

# Data Collection Form: Part A – Grant Award Information

Organization Name: Contact Person: Department of Contact Person:

PR/Award #: Project Period Begin Date: Project Period End Date:

Total Award Amount Obligated: The award amount includes the total amount obligated to your organization - both the original Grant Awards and any Supplemental Grant Awards - during the current project period. See the breakdown of funds across years below

. Please list the number of schools for each Fiscal Year that are still receiving CSP funds within your project period. On the following worksheets, you will provide information for each of these schools. Breakdown of Obligated Funds per Fiscal Year: Grant Award

Amount Supplemental

Award Amount Administrative

Expenditures Number of schools funded per Fiscal Year
FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 Total Number of Schools Funded: 

# 0

**Please turn to Part B**  **to provide data for each school**
**OMB Number: 1855-0016 Approval Expires 2/28/2015 Comments?** **If any of the above information is incorrect, or if you need to provide any additional information regarding your CSP grant, please use the box below. You may also direct comments to us at CSPdatacollection@Wested.org, or call toll-free 866-902-4887.** 

### Data Collection Form: Part B – School Award Information

**Total award amount obligated from ED (from Part A)--> $0**  **$0** <--Total **FY 2014**award amount from ED (from Part A) **$0** <--Total **FY 2013**award amount from ED (from Part A) **$0** <--Total **FY 2012**award amount from ED (from Part A) **$0** <--Total **FY 2011** award amount from ED (from Part A) **$0** <--Total **FY 2010**award amount from ED (from Part A) **Total administrative expenditures (from Parrt A)--> $0**  **$0** <--Total FY 2014 administrative expenditures (from Part A) **$0** <--Total FY 2013 administrative expenditures (from Part A) **$0** <--Total FY 2012 administrative expenditures (from Part A) **$0** <--Total FY 2011 administrative expenditures (from Part A) **$0** <--Total FY 2010 administrative expenditures (from Part A) **Total school funding amount (sum of column AC)--> $0**  **$0** <--Total FY 2014 dollars allocated (sum of column AD) **$0** <--Total FY 2013 dollars allocated (sum of column AI) **$0** <--Total FY 2012 dollars allocated (sum of column AN) **$0** <--Total FY 2011 dollars allocated (sum of column AS) **$0** <--Total FY 2010 dollars allocated (sum of column AX) **Total award amount remaining from ED (from Part A)--> $0**  **$0** <--Total remaining **$0** <--Total remaining **$0** <--Total remaining **$0** <--Total remaining **$0** <--Total remaining

**Minimum total award amount (mininum of column AI)--> $0**  **$0** <--Minimum FY 2014 award amount **$0** <--Minimum FY 2013 award amount **$0** <--Minimum FY 2012 award amount **$0** <--Minimum FY 2011 award amount **$0** <--Minimum FY 2010 award amount **Maximum total award amount (maximum of column AI)--> $0**  **$0** <--Maximumt FY 2014 award amount **$0** <--Maximumt FY 2013 award amount **$0** <--Maximumt FY 2012 award amount **$0** <--Maximumt FY 2011 award amount **$0** <--Maximumt FY 2010 award amount **Average total award amount (average of column AI)--> #DIV/0!**  **#DIV/0!** <--Average FY 2014 award amount **#DIV/0!** <--Average FY 2013 award amount **#DIV/0!** <--Average FY 2012 award amount **#DIV/0!** <--Average FY 2011 award amount **#DIV/0!** <--Average FY 2010 award amount

**Number of schools (count of column AI)--> $0**  **$0** <--Number of total schools FY 2014 **$0** <--Number of total schools FY 2013 **$0** <--Number of total schools FY 2012 **$0** <--Number of total schools FY 2011 **$0** <--Number of total schools FY 2010 **LEA Information F Y 2 0 1 4 F U N D S (10/1/14-9/30/15)**  **F Y 2 0 1 3 F U N D S (10/1/13-9/30/14) F Y 2 0 1 2 F U N D S (10/1/12-9/30/13)**  **F Y 2 0 1 1 F U N D S (10/1/11-9/30/12) F Y 2 0 1 0 F U N D S (10/1/10-9/30/11)** 

Charter school name School NCES ID address line 1 address line 2 city state zipcode LEA name LEA NCES ID address line 1 address line 2 city state zipcode Does the charter school act as its own LEA? Is it an LEA with

only charter schools? Authorizer Type (choose one) Authorizer Name address line 1 address line 2 city state zipcode Replication or Expansion CSP Funding Period Begin Date CSP Funding PeriodEnd Date Total CSP Funding Amount Dollar amount of CSP Funding Beginning date of

budget period End date of

budget period Grades Served in

2014-15 (if not opened, enter "0") School enrollment

in 2014-15 (if not opened, enter "0") Dollar amount of

CSP Funding Beginning date of

budget period End date of

budget period Grades Served in

2013-14 (if not opened, enter "0") School enrollment

in 2013-14 (if not opened, enter "0") Dollar amount of

CSP Funding Beginning date of

budget period End date of

budget period Grades Served in

2012-13 (if not opened, enter "0") School enrollment

in 2012-13 (if not opened, enter "0") Dollar amount of

CSP Funding Beginning date of

budget period End date of

budget period Grades Served in

2011-12 (if not opened, enter "0") School enrollment

in 2011-12 (if not opened, enter "0") Dollar amount of

CSP Funding Beginning date of

budget period End date of

budget period Grades Served in

2010-11 (if not opened, enter "0") School enrollment

in 2010-11 (if not opened, enter "0") School Status School year in which the school first enrolled students or planned opening date Grades served

prior to expenditure of CSP funds (if not opened, enter "0") School enrollment prior to expenditure of CSP funds (if not opened, enter "0") Planned Grades Planned Enrollment Previous CSP

Grant (Project Grade Levels) Previous CSP

Grant (Funding amount) School 1 School 2 School 3 School 4 School 5 School 6 **4) Charter School Operation.** Please indicate the school status, the school year in which the charter school first enrolled students, planned grades, planned enrollment, the grades served, enrollment data, and prior CSP awards. While we can access some of this information in EDFacts, it is not always available for charter schools, so we must also request it here. **1) Charter School Contact Information.** For each school funded, please identify: 1) the name and contact information for the charter school; and 2) the district/LEA information, including whether or not the school acts as its own LEA.

**Charter School Information Au**  **thorized Public Chartering Agency 2) Charter School Authorizer.**  Please identify the charter authorizer by type and name. **3) School Award Information.** Please provide the breakdown of funds awarded to schools from each Federal Fiscal Year. The total amount awarded across one or more years should equal the Total CSP Funding Amount for that school. In addition to providing the breakdown of funds awarded, please list the budget period for the time the funds were awarded.

### Data Collection Form: Part B – School Award Information

School 1 School 2 School 3 School 4 School 5 School 6 **Additional Comments.**

If you need to provide any additional information regarding this school, please use the box below. You may also direct comments to us at **CSPdatacollection@Wested.org** or call toll-free **866-902-4887**

.

# Data Collection Form: Summary Sheet

**Check your data:**

Organization Name: 

# 0 Contact Person: 

# 0 Department of Contact Person: 

# 0

PR/Award #: 

# 0 Project Period Begin Date: 

# 1/1/1904 Project Period End Date: 

# 1/1/1904

Total Award Amount Obligated: 

# $0

**|------------Summarized from Part A------------| |------------Summarized from Part B------------|**  Breakdown of Obligated Funds

per Fiscal Year: Grant Award

Amount Supplemental

Award Amount Number of new

school awards Minimum Award

Amount per fiscal year Maximum Award

Amount per fiscal year Average Award

Amount per fiscal year FY 2010 

# $0 **$0 0**  **$0 $0**  **#DIV/0!** FY 2011 

# $0 **$0 0**  **$0 $0**  **#DIV/0!** FY 2012 

# $0 **$0 0**  **$0 $0**  **#DIV/0!** FY 2013 

# $0 **$0 0**  **$0 $0**  **#DIV/0!** FY 2014 

# $0 **$0 0**  **$0 $0**  **#DIV/0!**
Total Number of Current Active School Awards: 

# 0 **$0 $0**  **#DIV/0!**
**Comments or questions? Please contact us at CSPdatacollection@Wested.org, or call toll-free 866-902-4887.** 

**OMB Number: 1855-0016 Approval Expires 2/28/2015** 

# This sheet summarizes the CSP Grant Award Data already provided in Part A and the CSP School Award data you entered in Part B. If there are discrepancies in the amount of funds obligated and awarded in each Federal Fiscal Year, please use the gray space below to explain.