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1. School / LEA Information

School Name
[School Name]
NCES ID
[NCES ID]
District / LEA
[District Name]
Address
[Street, City, State ZIP]
Principal
[Principal Name]
Title I Coordinator
[Coordinator Name & Email]
School Level
[Elementary / Middle / High]
Total Enrollment
[Number]
FRL Percentage
[XX%]
Title I Status
[Schoolwide / Targeted Assistance]
Title I Allocation
[$XX,XXX]

2. Item / Service Description

Describe the item(s) or service(s) to be purchased with Title I funds. Include product name, vendor, quantity, and unit cost.

ItemVendorQtyUnit CostTotal
[Item 1][Vendor][#][$][$]
[Item 2][Vendor][#][$][$]
[Item 3][Vendor][#][$][$]
Total Requested[$]

3. Needs Assessment

Describe the specific challenge or gap this purchase addresses. Use quantitative data from assessments, surveys, or federal data sources.

Write 3-5 sentences describing your school's need. Include specific data points. Example:

[e.g., "In the 2024-25 school year, only 28% of 3rd-grade students at [School Name] scored proficient or above on the state mathematics assessment, compared to the state average of 41%. The school's FRL rate of [XX%] correlates with limited access to hands-on instructional materials. Current classroom inventories show an average of 1 manipulative kit per 3 classrooms, significantly below the district's recommended 1:1 classroom-to-kit ratio. Teacher surveys indicate 87% of teachers report insufficient materials for CRA (Concrete-Representational-Abstract) instruction."]

4. Educational Purpose & Alignment

Explain how this purchase directly supports student academic achievement and aligns with the school's Title I plan.

Alignment to State Standards

[Identify the specific state academic standards this purchase addresses. Example: "Aligns with CCSS.Math.Content.3.OA — Operations and Algebraic Thinking, supporting concrete-representational-abstract (CRA) instructional methodology."]

Connection to School Improvement Plan

[Describe how this purchase connects to a specific goal, strategy, or action step in the school's Title I Schoolwide Plan or Targeted Assistance Plan. Reference the plan section number if possible.]

Target Student Population

[Identify the students who will benefit. Include grade levels, number of students, and any specific subgroups (economically disadvantaged, EL, SWD). For Schoolwide: all students. For Targeted Assistance: identified students meeting selection criteria.]

5. Title I Funding Alignment

Legal Authority: Elementary and Secondary Education Act (ESEA), as amended by the Every Student Succeeds Act (ESSA), Sections 1114 (Schoolwide Programs) and 1115 (Targeted Assistance Programs). CFDA 84.010A.

Eligible Use Category

Supplements Not Supplants

Compliance Statement: This purchase supplements and does not supplant existing state and local funding for instructional materials. The items described above are in addition to the core materials provided through the district's general fund. Evidence: [Describe what the district currently provides through non-Title I funds, and how this purchase goes beyond that baseline.]

6. ESSA Evidence Tier

Under ESSA, programs funded with Title I dollars should demonstrate evidence of effectiveness. Identify which ESSA evidence tier applies to this intervention.

TierStandardRequirement
Tier 1 — StrongAt least 1 well-designed experimental studyStatistically significant positive effects
Tier 2 — ModerateAt least 1 well-designed quasi-experimental studyStatistically significant positive effects
Tier 3 — PromisingAt least 1 correlational study with statistical controlsPositive effects with controls for selection bias
Tier 4 — Demonstrates RationaleWell-defined logic model based on researchOngoing effort to examine effects

Evidence Citation for This Intervention

Cite the specific research supporting this intervention. Include study name, source (e.g., What Works Clearinghouse), and ESSA tier.

[e.g., "The What Works Clearinghouse meta-analysis on manipulative-based mathematics instruction (2023) found moderate evidence (ESSA Tier 2) of positive effects on student achievement in elementary grades. IES Practice Guide: 'Assisting Students Struggling with Mathematics' recommends systematic use of concrete representations (Recommendation 3, Strong evidence)."]

7. SMART Goals & Measurable Objectives

Define goals using the SMART framework: Specific, Measurable, Achievable, Relevant, Time-bound.

Write 2-3 SMART goals. Each should specify what, how much, for whom, and by when.

[Goal 1: "By May 2027, the percentage of 3rd-grade students scoring proficient or above on the state math assessment will increase from 28% to 40%, as measured by annual state assessment results."]

[Goal 2: "By December 2026, 90% of K-5 classroom teachers will implement manipulative-based instruction in at least 3 math lessons per week, as measured by classroom observation logs."]

[Goal 3: "By May 2027, student engagement in mathematics as measured by the annual student survey will increase by 15% from the Fall 2026 baseline."]

8. Per-Pupil Cost Analysis

Demonstrate the cost reasonableness of this purchase on a per-pupil, per-year basis.

MetricValue
Total Purchase Cost[$X,XXX]
Students Served Per Class[25]
Classes / Sections Served[X]
Expected Useful Life (Years)[5]
Per-Pupil Per-Year Cost[Total / (Students × Classes × Years)]
Formula: Per-Pupil Cost = Total Purchase / (Students per Class × Classes Served × Useful Life Years)
Example: $8,500 / (25 × 4 × 5) = $17.00 per pupil per year

9. Budget Narrative

Provide a prose justification explaining why each line item is necessary, how costs were determined, and why the expenditure is reasonable.

Write 1-2 paragraphs connecting each budget item to the educational goals. Explain cost reasonableness.

[e.g., "The proposed purchase of [X] manipulative kits at [$X,XXX] each is based on competitive vendor pricing obtained through [process]. The per-pupil cost of $[X.XX] per year over the kit's 5-year useful life is well within the range of comparable instructional materials ($15-$30 per pupil per year per IES benchmarks). Each kit serves [X] students across [X] class sections, providing comprehensive coverage of the [subject] curriculum. The cost includes all required components as specified in the [curriculum/standards] framework, eliminating the need for supplementary purchases."]

10. Implementation Plan

PhaseTimelineActionResponsible
Procurement[Month]Purchase order submitted, delivery scheduled[Name]
Training[Month]Teacher PD on implementation and integration[Name]
Deployment[Month]Materials distributed, classroom use begins[Name]
Monitoring[Quarterly]Usage tracking, formative assessment review[Name]
Evaluation[End of Year]Outcome analysis, report to Title I committee[Name]

11. Evaluation Plan

Describe how the effectiveness of this investment will be measured, by whom, and on what schedule.

ComponentDetails
Evaluation Methodology[e.g., Pre-post comparison using state assessment data + classroom observation protocol]
Baseline Data[Current proficiency rate, engagement score, usage metrics as of [date]]
Target Outcomes[Specific targets from SMART goals above]
Assessment Instruments[State assessment, curriculum-based measures, observation rubric, student survey]
Data Collection Schedule[Baseline: Sep 2026 | Mid-year: Jan 2027 | End-of-year: May 2027]
Responsible Staff[Title I Coordinator, grade-level team leads, building principal]
Reporting Cadence[Quarterly progress reports to Title I committee; annual report to LEA]

12. Logic Model

Visual framework connecting inputs to long-term outcomes.

InputsActivitiesOutputsShort-Term OutcomesLong-Term Outcomes
[Title I funds, manipulative kits, PD hours, teacher time] [Teacher training, daily math instruction with manipulatives, student practice] [# teachers trained, # students served, # lessons using kits per week] [Increased student engagement, improved formative assessment scores, teacher confidence with CRA] [Increased state math proficiency, narrowed achievement gap, sustained instructional practice]

13. Sustainability Plan

Explain how the program will continue after the initial funding period ends.

Describe the durability of materials, ongoing costs (if any), and how instructional capacity will be maintained.

[e.g., "The manipulative kits have a minimum 5-year useful life with no consumable components requiring annual replacement. Professional development during Year 1 creates lasting instructional capacity — trained teachers will mentor incoming staff through the district's existing induction program. The school's Title I Schoolwide Plan will be updated to include manipulative-based instruction as a core strategy, ensuring continuation regardless of specific funding source. Should additional kits be needed due to enrollment growth, the per-unit cost of $[X,XXX] can be absorbed within the school's annual Title I allocation."]

14. Stakeholder Consultation

Requirement (ESSA Sec. 1116): Title I schools must conduct annual meaningful consultation with parents and community members regarding the school's Title I plan, including the use of funds. Parent input must be documented and considered in decision-making.

Document the stakeholder engagement conducted for this purchase decision:

Stakeholder GroupDate(s)MethodKey Input
[Parents / PTO][Date][Meeting / Survey][Input received]
[Teachers][Date][PLC / Survey][Input received]
[Community / Board][Date][Meeting][Input received]

15. Approval Signatures

Principal — Printed Name & Signature
Date
Title I Coordinator — Printed Name & Signature
Date
Business Manager / CFO — Printed Name & Signature
Date

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