WV 21ST CCLC SUMMARY AND ABSTRACT FORM (indicate number of schools in blank) Student Populations to be Served Elementary Schools ___ Middle Schools ___ High Schools ___ Title I schools ___ ___ Priority Schools ___ Schools Co-applicant Partner(s) and Collaborating Organizations (indicate number in ___ National Organizations or Municipal Agencies (e.g., police, Parks & (e.g., Boys & Girl Clubs, Recreation, Social Services) YMCA/YWCA, Big Brothers/Big Sisters) ___ Organizations or Universities (local non- profits or foundations) ___ Faith-Based Organizations ___ Libraries or Museums ___ Hospitals/Clinics/Health Providers ___ Businesses ___ other __________________________ Services to be Provided (check all that apply) or Literacy Physical Education Health, Nutrition Mathematics Technology, Video or Media Youth Development Science Service Learning Services for Adults Art, Music, Dance, Cultural Activities, Social Homework Help Theater Studies Tutoring Other ___________ of Operation Before school school Summer Weekend
WV 21ST CCLC SUMMARY AND ABSTRACT FORM Student Populations to be Served (indicate number of schools in blank) ___ Elementary Schools ___ Middle Schools ___ High Schools ___ Title I schools ___ Priority Schools ___ Schools Co-applicant Partner(s) and Collaborating Organizations (indicate number in ___ National Organizations (e.g., Boys & Girl Clubs, YMCA/YWCA, Big Brothers/Big Sisters) ___ Organizations (local non- profits or foundations) ___ Libraries or Museums ___ Businesses or Municipal Agencies (e.g., police, Parks & Recreation, Social Services) or Universities ___ Faith-Based Organizations ___ Hospitals/Clinics/Health Providers ___ other __________________________ Services to be Provided (check all that apply) or Literacy Mathematics Science Art, Music, Dance, Theater Physical Education Technology, Video or Media Service Learning Cultural Activities, Social Studies Health, Nutrition Youth Development Services for Adults Homework Help Tutoring Other ___________ of Operation Before school school Summer Weekend
201421stCCLCRFPFinal.docx