Community Health Initiative (CHI) - Organization Application for Student Consulting Projects

Youngstown City Schools Community Partnership Application 20 West Wood Street ~ Youngstown, Ohio 44503 Office of Community Partnerships Phone: (330) 742-2211 ~ Fax: (330) 744-5297 Community Partnership Application Proposal Long Form

Youngstown City Schools has created this application as a means of ensuring that community partners have the expertise to help meet the ongoing needs of students and their families in our school community. This application is for partnerships providing services that are not compensated by Youngstown City Schools.

Complete and submit by mail to: Youngstown City School District Attn: Claudia Charity, Manager of Community Partnerships 20 West Wood St. Youngstown, Ohio 44503

Approval Process INCOMPLETE APPLICATIONS AND THOSE ORGANIZATIONS NOT MEETING THE PROGRAM REQUIREMENTS WILL NOT BE CONSIDERED

Application is reviewed by the Community Partnership Team to ensure that all information is completed. New applicant’s references may be contacted. Preliminary screening is made by the Community Partnership team. You will be notified of the results of the screenings. It warranted, you will be scheduled for a 20-30 minute presentation with the Community Partnership Team. Once your application has been approved please contact the school(s) you are proposing to serve for final approval. Please give them a copy of your proposal and explain your program. If approved by the schools you propose to serve, you will be asked to complete a Memorandum of Understanding. MOU’s must be completed and sent to the Manager of Community Partnerships prior to starting your program. (A MOU is a document that expresses mutual accord on an issue between two or more parties.) Persons providing services will be required to submit a copy of criminal background check that includes a BCI, FBI and a drug screen. If the District has the information already on file, new copies are not required. BCI is good for life, FBI and Drug Screens for 5 years.

of 9 REVISED on 8/2013 Youngstown City Schools Community Partnership Application General Information

Organization Type

Please check only one: Non Profit: Business: Individual: Application Date: Organization Name: Address: Name of Program: Contact Person /Title: Phone: Email: Fax: Name of Executive Director/Business Owner: Phone: Email: Fax:

Organization Description

Services are provided for students in the following areas. Please check the area for which you are proposing to provide services. For every area checked, please provide measurable goals under questions number two and three in the next section.

Check all that apply Counseling Mentoring Tutoring Increased Achievement Leadership Development Career Planning Financial Literacy Afterschool Program Class Presentations Other: Other:

1a. For each school list the name of the proposed school, grades and the number of students you plan to serve. (Please list any additional schools on a separate sheet of paper and attach to application) Page 2 of 9 REVISED on 8/2013 Youngstown City Schools Community Partnership Application

School Grades Number of Students Number of Sessions

1b. Services to be provided: On school site Off school site

1c. Describe your proposal request in detail. Please be SPECIFIC WHEN DESCRIBING THE SCOPE OF THIS REQUEST:

1c. Describe the activities you will perform that helps the targeted population reach proposed goals

of 9 REVISED on 8/2013 Youngstown City Schools Community Partnership Application

1d. Describe the timeline to carry out your activities.

2. Describe how your program aligns with one or more of the components of the District’s Academic Recovery Plan (ARP) and Ohio Improvement Plan (OIP) by creating a SMART goal for each area you propose to address. (What will be different for the

of 9 REVISED on 8/2013 Youngstown City Schools Community Partnership Application target population if the project is successful? For how many? By when?) (Review SMART GOAL attachment for examples)

Components of the Academic Recovery Plan and Ohio Improvement Plan Increase student achievement in math Increase student achievement in reading School attendance improvement Reduction in disciplinary referrals

Component SMART GOAL: Specific, measureable, attainable, Evaluation Source of to be realistic and timely Tool baseline data addressed

Other SMART Goals

of 9 REVISED on 8/2013 Youngstown City Schools Community Partnership Application 3. Describe other SMART Goals your program will address that are not listed above.

SMART GOAL Evaluation Source of base Tool line data

Communication on Program Progress

4. There is an expectation from the District that you provide communication on the progress of your program. Describe the type of communication you propose to provide to each group and how often. (e.g. Phone, home visits, newsletters, face to face, workshops, etc.)

Targeted Students

Parents

Principal and teaching staff

Training/Experience

of 9 REVISED on 8/2013 Youngstown City Schools Community Partnership Application Please answer this question if you are a new applicant or this is a different program than you provided last year.

5. Describe your training/experience or your staff for the services you propose to provide.

Past Achievements

Please answer this question if you are a new applicant.

6. List past programs in the last two years you have provided for the District and measurable outcomes achieved.

References

of 9 REVISED on 8/2013 Youngstown City Schools Community Partnership Application Please complete this question if you are a new applicant.

List three references, including organization and phone number. Additionally, please provide details on the services provided and impact.

Reference 1 Name: Title: Organization/Department: Phone:

Details:

Impact:

Details:

Impact:

Details:

Impact:

Thank you for your participation in our application proposal process. We are not accepting emailed applications. Please mail this proposal to: Youngstown City School District Attn: Claudia Charity, Manager of Community Partnerships 20 West Wood St. Youngstown, Ohio 44503

SMART GOALS

of 9 REVISED on 8/2013 Youngstown City Schools Community Partnership Application EXAMPLE EXAMPLE EXAMPLE EXAMPLE

SMART GOAL Evaluation Tool Source of Base Line Data EXAMPLE By 2013 number of students OAA Scores to be 2013 Ohio proficient in reading will have obtained through the Achievement increased by 12% District Scores compared to 2012 EXAMPLE By 2013 -50% of students Report Card November report served will increase 1 letter card grade in reading comparing first grade period with final grade EXAMPLE 75% of our students will meet Nine Week Report NA the attendance goal of not Cards obtained from missing more than 2 days per the schools or District grade period Data Center EXAMPLE To decrease the number of Disciplinary records 2012 disciplinary suspensions for 50% of the obtained from records compared students served. principal of to 2013 individual schools or designee EXAMPLE During the 2012-2013 school Name of the Pre test year, at least 65% of the girls instrument you are who have attended group using and what it sessions will show an measures improvement in the way they think about themselves, identify positive qualities, and learn to deal with negative influences

of 9 REVISED on 8/2013