# Purpose of Data Collection: The new data collection will collect CSP grant award information from grantees (State Educational Agencies (SEAs) and non-SEAs) to create a new database of data from current applicants receiving a CSP grants. 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. 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. 

# For Direct Grant Recipients: 

# Charter Schools Program (CSP) **Office of Innovation and Improvement U.S. Department of Education**  **CSP Data Collection Form - Non-SEA Grantees**

**Instructions**

Charter schools (or other organizations) receiving CSP grants directly from the U.S. Department of Education are asked to complete the following worksheet entitled "Data Collection Form: Direct Grant Recipients." This form has two parts. 

# Part Aasks for confirmation of CSP nonSEA award information. The school/grantee name, contact person, and PR/award number has already been entered in the form. If this information is incorrect, please contact the data collection administrators (see "Contact Information" below). 

# Part Basks for specific CSP award information that is not included in your Grant Award Notification (GAN). **Please provide the following information for your non-SEA award: 1) the name and contact information for the charter school and LEA; 2) the charter school's**  **management organization (CMO, EMO or freestanding); 3) the authorized public chartering agency; 4) the total amount of funding an applicant received to start a charter**  **school, along with the amount of funds expended and the beginning and end date of the grant project period and budget periods; and 5) other charter school information (e.g.,**  **enrollment) as needed.** If an electronic copy cannot be sent, please send a paper copy of the completed data collection form to the following address: Completed CSP Data Collection Forms should be sent to 

# CSPdatacollection@w**ested.org** . In the subject heading please include "CSP Data Collection" followed by your school name. Please be sure to save a copy of the completed form for your own records.

**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. W estEd



# 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, W ashington, 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, W ashington D.C. 20202-2800. 

# Contact Information: If you have any questions or concerns regarding the completion of the data collection form, please contact W estEd. You can email us at 

# CSPdatacollection@Wested.org , or call tollfree 

# 866-902-4887 . Attn: CSP Data Collection

### Supplemental Award Amount FY 2011 

## $0 Total Award Amount Obligated: FY 2014 

# Charter Schools Program **Office of Innovation and Improvement U.S. Department of Education**  **Part A**

PR/Award #: Title of Contact Person: 

# Data Collection Form: Non-SEAs School: School Contact Person: Project Period Begin Date: Project Period End Date: Breakdown of Obligated Funds per Fiscal Year

**OMB Number: 1855-0016 Approval Expires 2/28/2015** Grant Award Amount Administrative Expenditures FY 2013



## Please turn to **Part B to provide specific data for your grant**  **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@W ested.org, or call toll-free 866-902-4887.

FY 2012School enrollment and waitlist figures in 2010-11 **3) Charter School Operation** School enrollment (if not opened, enter "0") Number of

students on waitlist to enroll each year (if not opened, enter "NA") School year in which the school first enrolled students **Part B: CSP Grant Award Information**
**1) Charter School Contact Information** Part B asks for specific CSP award information that is not included in your Grant Award Notification (GAN). Please provide the following information for your non-SEA award: 1) the full name and contact information for the charter school (and charter developer, if different than the charter school); 2) The total amount of funding an applicant received to start a charter school; 3) the beginning and end date of the grant project period and budget periods; and 4) other charter school information as needed.

Beginning date of grant budget period End date of grant budget period Type of grant (choose one) $

School enrollment and waitlist figures in 2006-07 Management Organization Name **Charter School Management Organization Charter School Name and Contact Information** 

zipcode: 

### Data Collection Form: Non-SEAs (continued)

state: Charter school name

zipcode: **2) Grant Award and Expenditures Information Please provide the breakdown of funds obligated to this grantee from**  **each Federal Fiscal Year and the amount of funds expended. The total amount obligated across one or more years should equal the**  **Total Award Amount provided on the left.** Project Period End Date Does the charter school act as its own LEA? zipcode:

zipcode: city: address line 2: address line 2:

Totals

Project Period Begin Date

FY 2014 **In addition to providing the breakdown of funds obligated, please list the budget period for the time funds were obligated, and whether the**  **awards were used for preplanning, planning, implementation or dissemination purposes.** 

$ Total amount expended to date $ $ Dollar amount of grant award Total Grant Award Amount Obligated: $ state: Is it an LEA with only charter schools? LEA mailing address

$ Management Organization Type

state: address line 1: School mailing address Management Organization address

city: School NCES ID address line 1:

Authorizer Name address line 2: Authorizer Type (choose one) LEA name **LEA Information** LEA NCES ID address line 2: city: Authorizer mailing address

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

**OMB Number: 1855-0016 Approval Expires 2/28/2015** School enrollment and waitlist figures in 2013-14 School enrollment and waitlist figures in 2014-15

**Thank you very much for your cooperation.** School enrollment and waitlist figures in 2009-10 School enrollment and waitlist figures in 2008-09 School enrollment and waitlist figures in 2007-08 School enrollment and waitlist figures in 2011-12 School enrollment and waitlist figures in 2012-13 Anticipated expenditures through end of FY **$0.00 $0.00**  $ mm/dd/yy $ $ mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy The remainder above is the carryover amount mm/dd/yy mm/dd/yy mm/dd/yy **$0.00** state: address line 1:

city: address line 1: **Authorized Public Chartering Agency**

FY 2011 $ FY 2013 FY 2012

$ $ **$0.00** $