21st Century Community Learning Centers 2 Applicant (Name of Program): Program Director: Program Director E-Mail: be to as once) once) to Lunch grades CCLC CCLC No School only only of No School No Proficient indicator Name of each School and School 21st students adults Enrollment 21st (N)- (N) (N) School High of District to be served by 21st CCLC by of Focus Identified Reduced I # # by student student or Yes English Yes Yes or served) poverty Students and School Title enrollment (Y) (Y) each each (Y)- served other Middle served Free be Previously Limited Priority Total % or % Estimated Estimated (Total (Count (Count School District: School: Principal’s Signature: School District: School: Principal’s Signature: School District: School: Principal’s Signature: School District: School: Principal’s Signature: School District: School: Principal’s Signature: (If you need more space, please include another copy of this chart.)
21st Century Community Learning Centers 2 Applicant (Name of Program): Program Director: Program Director E-Mail: Name of each School and School District to be served by 21st CCLC Total School Enrollment (Total enrollment of grades served) Title I School (Y)- Yes (N)- No % Free and Reduced Lunch or other poverty indicator % Limited English Proficient Students Estimated # of students to be served by 21st CCLC (Count each student only once) Estimated # of adults to be served by 21st CCLC (Count each student only once) Previously Identified as Priority or Focus School (Y) Yes (N) No Middle or High School (Y) Yes (N) No School District: School: Principal’s Signature: School District: School: Principal’s Signature: School District: School: Principal’s Signature: School District: School: Principal’s Signature: School District: School: Principal’s Signature: (If you need more space, please include another copy of this chart.)