Site Name Site Name Physical Site Address Physical Site Address City, State, and Zip City, State, and Zip Site Contact Person Site Contact Person Site Contact Phone Site Contact Phone Site Contact E-mail Site Contact E-mail Site Name Physical Site Address City, State, and Zip Site Contact Person Site Contact Phone Site Contact E-mail PROGRAM AND A. List each site name to be served in table below. For each site, answer columns across the table. Specify: List all grade Data regarding the school/district attended by the students during the regular Name of site each levels of school day. Proposed # Urban (U), Rural students School Name *% Free ** Actual of students (R), or Suburban to be to be served (if more than one or (S) served school sends District School Type Reduced at each site at each students to this Name Cost enrollment CCLC site, list all Lunch of for each site schools) each school school building building Site: Public □ Private □ S □ U □ R □ Site: Public □ Private □ S □ U □ R □ Site: Public □ Private □ S □ U □ R □
Site Name Site Name Physical Site Address Physical Site Address City, State, and Zip City, State, and Zip Site Contact Person Site Contact Person Site Contact Phone Site Contact Phone Site Contact E-mail Site Contact E-mail Site Name Physical Site Address City, State, and Zip Site Contact Person Site Contact Phone Site Contact E-mail PROGRAM AND A. List each site name to be served in table below. For each site, answer columns across the table. Specify: Name of each site Urban (U), Rural (R), or Suburban (S) List all grade levels of students to be served at each CCLC site Data regarding the school/district attended by the students during the regular school day. Proposed # of students to be served at each site School Name (if more than one school sends students to this site, list all schools) District Name School Type *% Free or Reduced Cost Lunch of each school building ** Actual enrollment for each school building Site: □ U □ R □ S □ Public □ Private Site: □ U □ R □ S □ Public □ Private Site: □ U □ R □ S □ Public □ Private
FY14%2021st%20CCLC%20RFA.docx