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 A asks 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 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 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@wested.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.

 WestEd

 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 data collection form, 

please contact WestEd. You can email us at CSPdatacollection@Wested.org, or call tollfree 866-902-4887.

 Attn: CSP Data Collection
Supplemental Award Amount

 FY 2011

Total Award Amount Obligated: $0

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@Wested.org, or call toll-free 866-902-4887. 

 FY 2012
School 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 Name and Contact Information Charter School Management Organization

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:

LEA name Authorizer Type (choose one)

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@Wested.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