Part I – general




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MASSACHUSETTS DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

STANDARD CONTRACT FORM AND APPLICATION FOR PROGRAM GRANTS

PART I – GENERAL



A. APPLICANT:


District Code:















ADDRESS:




TELEPHONE: ( )






B. APPLICATION FOR PROGRAM FUNDING




790

Alternative Education State Grant: Education Pathways to Support Students Most At-Risk of Not Graduating from High School (Competitive)


PROJECT DURATION



AMOUNT

REQUESTED


FY2015


STATE GRANT

administered by the

OFFICE OF COLLEGE AND CAREER READINESS


FROM


TO








Upon Approval

6/30/15



C. I CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS CORRECT AND COMPLETE; THAT THE APPLICANT AGENCY HAS AUTHORIZED ME, AS ITS REPRESENTATIVE, TO FILE THIS APPLICATION; AND THAT I UNDERSTAND THAT FOR ANY FUNDS RECEIVED THROUGH THIS APPLICATION THE AGENCY AGREES TO COMPLY WITH ALL APPLICABLE STATE AND FEDERAL GRANT REQUIREMENTS COVERING BOTH THE PROGRAMMATIC AND FISCAL ADMINISTRATION OF GRANT FUNDS.




AUTHORIZED SIGNATORY:


TITLE:


TYPED NAME:


DATE:




DATE DUE: November 26, 2014

Proposals must be received at the Department by 5:00 p.m. on the date due.

Mail the Fund Code 790 proposal listed on this signature page to:
Carrie Harrington

Office of College and Career Readiness
Massachusetts Department of Elementary and Secondary Education
75 Pleasant Street
Malden, MA 02148-4906

Number of sets: 2

DO NOT WRITE BELOW THIS LINE







MASSACHUSETTS DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION USE ONLY



GRANTS MANAGEMENT


For the Department Authorized Signatory:


Date:


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