Appendix B
Application Forms
Contact Page
Application Consortium
Data Sheet
Application Abstract
Annual Workplan
Instructions
for Completing the Annual Workplan
Application
Budget Summary
Application
Budget Detail Sheet
(Blank)
Application Budget
Detail Sheet (Format Example
Only)
Crossover Chart (Double-Sided Document)
To
Be Completed By district
Chancellor’s
Office
California Community Colleges
RFA Specification No.: 08-0342-
District:
College:
To
Be Completed By COCCC
Contact Page
Grant Agreement No.:
08-0342-
Proposal ID No.:
Funding Status:
Fiscal Year:
08-09
Funding
Source(s): Title I-B Leadership
RFA Specification Title:
Regional Consortium
Institution:
Address:
City: State:
Zip+4:
–
District
Superintendent (or authorized Designee)
Name: Title:
Phone: (
)Date:
Fax: (
)E-Mail Address:
Responsible
Administrator (Appropriate Program Area)
Name: Title:
Phone: (
)Date:
Fax: (
)E-Mail Address:
Project
Director
Name: Title:
Phone: (
)Date:
Fax: (
)E-Mail Address:
Business
Officer
Name: Title:
Phone: (
)Date:
Fax: (
)E-Mail Address:
Grant
Writer
Name: Title:
Phone: (
)Date:
Fax: (
)E-Mail Address:
To
Be Completed By district
Chancellor’s Office
California Community Colleges
RFA Specification No.:
08-0342-
District:
College:
Application
Consortium Data Sheet
Complete
the following information for each college of the consortium.
Use additional sheets if required. Attach this form directly behind
the Contact Page.
District/College:
Address:
City: State:
Zip:
Project Contact:
Phone: Fax No.:
E-Mail Address:
Portion of funds being
allocated to district/college: $ (if known)
Role of district/college
in the consortium design:
District/College:
Address:
City: State:
Zip:
Project Contact:
Phone: Fax No.:
E-Mail Address:
Portion of funds being
allocated to district/college: $(if known)
Role of district/college
in the consortium design:
District/College:
Address:
City: State:
Zip:
Project Contact:
Phone: Fax No.:
E-mail Address:
Portion of funds being
allocated to district/college: $ (if known)
Role of district/college
in the consortium design:
Chancellor’s
Office
California Community Colleges
RFA Specification No.:
08-0342-
District:
College:
To
Be Completed By COCCC
Application Abstract
Amount Awarded: $
Project
Title:
Project
Director:
Organization:
Address:
City:
State: Zip + 4:
—
Phone:
( )Fax: (
)E-mail Address:
(PLEASE SUBMIT YOUR ABSTRACT AS HARD COPY
AND ON A DISKETTE IN ANY OF THE
FOLLOWING FORMATS:
IBM COMPATIBLE; ASCII TEXT FORMAT
OR PREFERABLY MS WORD
97 DOCUMENT (OR LOWER VERSION)
(Summarize
in approximately 250 words or less; limit one page.)
ANNUAL
WORKPLAN
Performance/Funding
Period: 07/1/08 – 06/30/09
RFA
Specification No. and Title: 08-0342-
District: _____________________________________________College:
______________________________________
*OBJECTIVE No. ____:
Activities
Performance Outcomes
Timelines
Responsible Persons
* Limit one (1) objective per page.
List objectives according to numerical order, i.e., 1.0. Activities
should have corresponding numbers (i.e., 1.1, 1.2, 1.3 . . .)
Instructions
for Completing the Application Annual Workplan
The Annual Workplan serves
as the statement of work for the proposed project. This form will
be used to outline the project’s objectives, activities, performance
outcomes, projected timeline, and responsible persons. The Annual
Workplan also serves as the major foundation for linking the various
pieces of the application together. Thus, it is important that
objectives of the work plan are clearly stated and each corresponding
activity delineated along with appropriate timelines, performance outcomes,
and responsible persons.
Objectives
Activities
Performance Outcomes
Timelines
Responsible Persons
Objectives
The objectives should serve as the statement
of purpose or intent of the project. Use the “Required Objectives”
in the RFA Specification as a guide for writing objectives for the application.
Proposed project objectives should be based on the scope of the proposed
project while remaining consistent with the required objectives (purposes
and intent) set forth in the RFA Specification.
Example:
Eighty percent (80%) of the 35 faculty completing the Internet Professional
Development workshop will incorporate into their classroom best practices
learned as evidenced by revised curriculum outlines and team teaching
strategies.
One objective should
be listed, along with corresponding activities, performance outcomes,
timelines, and responsible persons on one page. Label the objectives
in sequential order: Objective #1.0 at the top of page one; Objective
#2.0 at the top of page two, and so forth. One additional page
can be used, if needed, for each objective. In addition, objectives
should be stated in measurable terms.
Activities
Project activities are
the scope of tasks that need to be completed in order to achieve the
project objectives. Activities and tasks are the basic steps that
need to be taken to operationalize the project and to achieve results.
Activities should also be linked to performance outcomes. Major
activities and tasks should be outlined in the activities section of
the Annual Workplan for each objective.
List all major activity
associated with each objective. Each objective should be numbered
in sequential order as outlined above. Corresponding activities
should use the same number as the objective. This means listing
the activities in numerical order (e.g., 1.1, 1.2, 1.3 . . .).
Performance Outcomes
Outcomes should relate
to the project objectives and activities. The application should
identify the type of documentation to be used to show evidence of achievement.
Each RFA Specification has an example of the types of deliverables that
may be used for the purpose of documentation.
Timelines
This should provide a
weekly or monthly calendar of projected completion dates for key activities.
Responsible Persons
Individuals responsible
for completing key activities should be identified by name and position.
Application Budget
Summary
Fiscal Year
2008-09
RFA Specification No.:
08-0342
RFA Specification Title:
District:
College:
Telephone No.:
Fax. No.:
Note:When entering
dollar amounts, round off to nearest dollar.

Provide an Application Budget Detail Sheet for each funding source including
matching sources, if required, either for cash or in-kind.
Object of Expenditure/Classification
Line
Source of Funds
VTEA Title I-B
– State Leadership
1000Instructional
Salaries1
1
2000Non instructional
Salaries1
2
3000Employee Benefits
3
4000Supplies and Materials
4
5000Other Operating
Exp. & Svcs.
5
6000Capital Outlay
6
7000Other Outgo
7
Total Direct Costs1
8
Total Indirect Costs2
9
Total Costs
10
1 Administration is limited to 5%
of the total direct costs.
2 Not to exceed 4% of the total
direct costs.
I authorize this cost proposal as
the maximum amount to be claimed for this project and assure that funds
shall be spent in compliance with State and federal regulations.
Project Director Signature:
Date:
District Chief Business Officer/
Authorized Designee: Date:
Must be completed for each funding
source
Chancellor’s Office
California Community Colleges
RFA
Specification No.: 08-0342-
District:
College:
Application Budget
Detail Sheet
Program
Year: 08-09
Source of Funds:
Title I-B Leadership
Object
of Expenditure
Classification
Amount
Total Direct Costs
Total Indirect Costs (Not to Exceed 4%
of Direct Costs)
Total Costs
FORMAT
EXAMPLE ONLY
Chancellor’s Office
California Community Colleges
RFA Specification
No.:
District:
College:
Application Budget
Detail Sheet
Program
Year:
2008-09
Source of Funds:
Fill In
Object
of Expenditure1
Classification
Project Funds
Requested
1100
Instructional Salaries
Name/Classification
(Days/hours) x (Daily/hourly rate) = $
Fill In
1210
Supervisors’ Salaries2
Name/Classification
(Days/hours) x (Daily/hourly rate) = $
1230
Counselors’ Salaries
Name/Classification
(Days/hours) x (Daily/hourly rate) = $
1420
Project Director3
Name/Classification
(Days/hours) x (Daily/hourly rate) = $
2140
Classified Salaries, Noninstructional
(Regular Full-time)
Name/Classification
(Days/hours) x (Daily/hourly rate) = $
2200
Instructional Aides’ Salaries
(Regular, Full-time)
Name/Classification
(Days/hours) x (Daily/hourly rate) = $
2340
Classified Salaries, Noninstructional
(Non-Regular Full-time)
Name/Classification
(Days/hours) x (Daily/hourly rate) = $
2400
Instructional Aides’ Salaries
(Non-Regular, Full-time)
Name/Classification
(Days/hours) x (Daily/hourly rate) = $
3000
Employee Benefits
Name and rate change
4000
Supplies and Materials
List type and costs
5000
Other Operating Expenses and Services
List type and costs, including travel and per diem
Subcontractors
Name (daily/hourly rate)
Identify specific service to be rendered
6000
Capital Outlay
List type and costs
Equipment
7000
Other Outgo
List type and costs
Student financial aid
Other payments to/for students
Total Direct Costs
Total Indirect Costs (Not to exceed 4%
of Direct Costs)
Total Costs
Crossover Chart
Expenditure by Object Titles (EOT)*
Use This
(VTEA Reports EOT Number)
For This
(Budget and Accounting
Manual EOT Number)
1100
Instructional
Salaries
1100
Academic Salaries, Instructional,
Contract or Regular Status
1300
Academic Salaries, Instructional,
Other
1210
Supervisor1
1200
Academic Salaries, Noninstructional,
Contract or Regular Status
Subcategory Administrators and Supervisors:
(Superintendents, Assistant Superintendents, Presidents, Vice Presidents,
Deans)
1220
Project Director2
1200
Academic Salaries, Noninstructional,
Contract or Regular Status
Subcategory Project Director
1230
Counselor
1200
Academic Salaries, Noninstructional,
Contract or Regular Status
Subcategory Vocational Counselors
1240
Other
1200
Academic Salaries, Noninstructional,
Contract or Regular Status
Subcategory Other: (Salaries
other than Administrators/Supervisors, Project Directors, and Vocational
Counselors in contract or regular noninstructional academic positions)
1400
Noninstructional
Salaries
(Use same subcategory detail as object
1200)
1400
Academic Salaries, Non-Instructional
Salaries, Other
1410
Supervisor1
1420
Project Director2
1430
Counselor
1440
Other
2100
Classified Salaries,
Noninstructional
(Use same subcategory detail as object
1200)
2100
Classified and Other Nonacademic
Salaries, Noninstructional, Regular Status
2110
Supervisor1
2120
Project Director2
2130
Counselor
2140
Other
2200
Instructional
Aides’ Salaries
2200
Classified and Other Nonacademic
Salaries, Instructional Aids, Regular Status
Direct Instruction, Other
*
Please refer to the
California Community Colleges Budget and Accounting Manual (Rev. July
2000). This manual is available on the Chancellor
’
s Office Website (