Form C-1: School Year Activities by Category For instructions, see page 5. ________________________________ ________________________________ Grantee Name Center Name EXAMPLE Activity or Service Typical Number of Hours Per Week Typically, How Often Was This Type of Activity Provided? Was This Type of Activity Provided Across the Whole School Year? 4–5 Times a Week 1–3 Times a Week 1–3 Times a Month Less Than Once a Month 1. Academic improvement or remediation programs 10 x Yes Activity or Service Typical Number of Hours Per Week Typically, How Often Was This Type of Activity Provided? Was This Type of Activity Provided Across the Whole School Year? 4–5 Times a Week 1–3 Times a Week 1–3 Times a Month Less Than Once a Month Activities Targeting Student Attendees 1. Academic enrichment learning programs 2. Tutoring 3. Homework help 4. Mentoring Activity or Service Typical Number Typically, How Often Was This Type of Activity Provided? Was This Type of
of Hours Per Week Activity Provided Across the Whole School Year? 4–5 Times a Week 1–3 Times a Week 1–3 Times a Month Less Than Once a Month Activities Targeting Student Attendees 5. Recreational activities 6. Drug- and violence-prevention, counseling, and character-education programs 7. Career or job training for youth 8. Expanded library service hours 9. Supplemental educational services 10. Community service or service-learning programs 11. Activities to promote youth leadership 12. Other: ___________ _________________ _________________ Activity or Service Typical Number of Hours Per Week Typically, How Often Was This Type of Activity Provided? Was This Type of Activity Provided Across the Whole School Year? 4–5 Times a Week 1–3 Times a Week 1–3 Times a Month Less Than Once a Month Activities Targeting Adult Family Members* 13. Programs that promote parental involvement 14. Programs that promote family literacy
Form C-2: School Year Activities by Student Populations Targeted For instructions, see page 5. Activity or Service Typical Number of Hours Per Week Typically, How Often Was This Type of Activity Provided? Was This Type of Activity Provided Across the Whole School Year? 4–5 Times a Week 1–3 Times a Week 1–3 Times a Month Less Than Once a Month Activities Targeting Specific Student Populations 1. Students who are not performing at grade level, are failing, or otherwise are performing below average 2. students 3. Students who have been truant, suspended, or expelled 4. Students with special needs or disabilities 5. Other: ____________ __________________ proficient
Form C-4: Summer Activities by Category For instructions, see page 5. Activity or Service Typical Number of Hours Per Week Typically, How Often Was This Type of Activity Provided? Was This Type of Activity Provided Across the Whole School Year? 4–5 Times a Week 1–3 Times a Week 1–3 Times a Month Less Than Once a Month Activities Targeting Student Attendees 1. Academic enrichment learning programs 2. Tutoring 3. Homework Help 4. Mentoring 5. Recreational activities 6. Drug- and violence-prevention, counseling, and character-education programs 7. Career or job training for youth 8. Expanded library service hours 9. Supplemental educational services
Form C-5: Summer Activities by Student Populations Targeted For instructions, see page 5. Activity or Service Typical Number of Hours Per Week Typically, How Often Was This Type of Activity Provided? Was This Type of Activity Provided Across the Whole School Year? 4–5 Times a Week 1–3 Times a Week 1–3 Times a Month Less Than Once a Month Activities Targeting Specific Student Populations 1. Students who are not performing at grade level, are failing, or otherwise are performing below average 2. students 3. Students who have been truant, suspended, or expelled 4. Students with special needs or disabilities 5. Other: ____________ __________________ proficient
Form C-6: Summer Activities by Subject Area For instructions, see page 5. Activity or Service Typical Number of Hours Per Week Typically, How Often Was This Type of Activity Provided? Was This Type of Activity Provided Across the Whole School Year? 4–5 Times a Week 1–3 Times a Week 1–3 Times a Month Less Than Once a Month Activities Addressing a Specific Subject Area 1. Reading or literacy education activities 2. Mathematics education activities 3. Science education activities 4. Arts and music education activities 5. Entrepreneurial education programs 6. Telecommunications and technology education programs 7. Cultural activities or social studies 8. Health- or activities 9. Other: _____________ Activity Description (Optional) If you would like, provide a description of one of the summer activities here. This section is optional and is not required to complete your APR.
Form F-2: State Assessment–Current Year (Combined) For instructions, see page 10. ________________________________ ________________________________ Grantee Name Center Name State Assessment Proficiency Results—Overview Indicate the number of regular attendees for which: Regular Attendees You have both mathematics and reading/language arts results for the state proficiency test administered during the 2014–15 school year. You have only mathematics results for the state proficiency test administered during the 2014–15 school year. You have only reading/language arts results for the state proficiency test administered during the 2014–15 school year. You have neither mathematics nor reading/language arts results for the state proficiency test administered during the 2014–15 school year. Totals State Assessment Proficiency Results—Mathematics Performance Indicate the number of regular attendees who scored in the following levels on the state proficiency test administered during the reporting period (NOTE: Enter the proficiency levels for your state below from highest to lowest.) Regular Attendees Total (Mathematics)
Indicate the number of regular attendees in each level who: Number of Regular Attendees Number of regular attendees who witnessed a jump from a category two levels below proficient to the proficient performance level or above on the proficiency test. Number of regular attendees that witnessed a jump from a category three levels below proficient to the proficient performance level or above on the proficiency test.