Immigrant Children & Youth Education Grant Application

APPENDIX A
RFP 136
Rev. 9/2011
20 USC 6961 et
seq., as
amended by
P.L. 107-110
CONNECTICUT STATE DEPARTMENT OF EDUCATION
Division of Teaching, Learning and Instructional Leadership
Hartford
Immigrant Children and Youth Program (ICYG)
Grant Application for 2012-13
INSTRUCTIONS
Submit original and three copies by
November 9, 2012
MAIL TO:
Carla Ghostlaw
Connecticut State Department of Education
Division of Teaching, Learning and Instructional
Leadership
P.O. Box 2219, Room 215
Hartford, CT 06145-2219
Name of School District: _____________________________________ Town/District Code:_______
Contact Person’s Name & Title: ________________________________________________________
Address: ___________________________________________________________________________
___________________________________________________________________________
Phone: ___________________ Fax: _________________ E-mail: ____________________________
Date of Local Board Acceptance: _______________________________________________________
I hereby certify that the information contained in this application is true and accurate to the best
of my knowledge and belief.
________________________________
Signature of Superintendent of Schools
_______________
Date
PART I: STATISTICAL DATA:
TOTAL PUBLIC AND
NONPUBLIC
PK-12 SCHOOL ENROLLMENT
TOTAL PUBLIC AND NONPUBLIC
SCHOOL ENROLLMENT OF ELIGIBLE
IMMIGRANT STUDENTS *
AMOUNT OF GRANT FUNDS
REQUESTED FOR PUBLIC AND
NONPUBLIC SCHOOLS
PUBLIC
__________
PUBLIC
__________
NONPUBLIC
TOTAL:
__________
NONPUBLIC __________ $________________________
TOTAL:
* Please refer to your copy of the Immigrant Children and Youth Survey Form–ED 236 for 2011-12.
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