1. LEA / School Information
- District / LEA
- [District Name]
- School(s)
- [School Name(s)]
- NCES ID(s)
- [NCES ID(s)]
- SSAE Coordinator
- [Name & Email]
- Title IV-A Allocation
- [$XX,XXX]
- Fiscal Year
- [FY XXXX]
2. Title IV-A Three Pillars
Title IV-A funds must be distributed across three content areas. LEAs receiving ≥$30,000 must allocate at least 20% to well-rounded education and 20% to safe and healthy students. Indicate your allocation:
Pillar 1: Well-Rounded Education
STEM, arts, civics, AP/IB, college/career readiness, foreign language
Min 20% of allocation
Amount: [$X,XXX]
Pillar 2: Safe & Healthy Students
Mental health, drug/violence prevention, health education, school climate
Min 20% of allocation
Amount: [$X,XXX]
Pillar 3: Effective Use of Technology
Ed-tech, digital literacy, blended learning, devices, professional development
No minimum required
Amount: [$X,XXX]
3. Item / Service Description
Describe each item or service and map it to the appropriate pillar.
| Item / Service | Pillar | Qty | Unit Cost | Total |
|---|---|---|---|---|
| [Item 1] | [1/2/3] | [#] | [$] | [$] |
| [Item 2] | [1/2/3] | [#] | [$] | [$] |
| [Item 3] | [1/2/3] | [#] | [$] | [$] |
| Total Requested | [$] | |||
4. 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."]
5. Educational Purpose & Evidence Base
Identified Need
[Describe the specific need this purchase addresses. Reference your LEA's comprehensive needs assessment. Example: "Student proficiency in STEM subjects declined 8% over the past two years (EDFacts data). Teachers report insufficient hands-on learning materials for grades K-5."]
Well-Rounded Education Alignment (Pillar 1)
[If applicable, explain how this purchase provides access to a well-rounded education per Sec. 4107. Example: "STEM manipulative kits provide equitable access to hands-on mathematics instruction aligned to CCSS, ensuring students in Title I schools receive the same quality of concrete learning experiences as their peers in higher-resourced schools."]
Evidence Base
[Cite the evidence supporting this intervention. ESSA evidence tiers: Tier 1 (Strong), Tier 2 (Moderate), Tier 3 (Promising), Tier 4 (Demonstrates Rationale). Example: "What Works Clearinghouse meta-analysis on manipulative-based math instruction shows moderate evidence (Tier 2) of positive effects on student achievement."]
6. ESSA Evidence Tier
Under ESSA, programs funded with Title IV-A dollars should demonstrate evidence of effectiveness. Identify which ESSA evidence tier applies to this intervention.
| Tier | Standard | Requirement |
|---|---|---|
| Tier 1 — Strong | At least 1 well-designed experimental study | Statistically significant positive effects |
| Tier 2 — Moderate | At least 1 well-designed quasi-experimental study | Statistically significant positive effects |
| Tier 3 — Promising | At least 1 correlational study with statistical controls | Positive effects with controls for selection bias |
| Tier 4 — Demonstrates Rationale | Well-defined logic model based on research | Ongoing 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. Comprehensive Needs Assessment Reference
- CNA Completion Date
- [Date of most recent CNA]
- CNA Methodology
- [Surveys, focus groups, data analysis, etc.]
- CNA Finding
- [Specific finding from CNA that supports this purchase]
- CNA Page/Section Ref
- [Page number or section of CNA document]
8. 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."]
9. Per-Pupil Cost Analysis
| Metric | Value |
|---|---|
| Total Purchase Cost | [$X,XXX] |
| Students Served | [Number] |
| Expected Useful Life (Years) | [X] |
| Per-Pupil Per-Year Cost | [$X.XX] |
10. Budget Narrative
Provide a prose justification explaining why each line item is necessary, how costs were determined, and why the expenditure is reasonable.
Write 1-2 paragraphs connecting each budget item to the educational goals. Explain cost reasonableness.
[e.g., "The proposed purchase of [X] manipulative kits at [$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."]
11. Implementation & Evaluation Plan
| Milestone | Timeline | Outcome Measure |
|---|---|---|
| Procurement & delivery | [Month] | Materials received and inventoried |
| Teacher training | [Month] | 100% of target teachers trained |
| Classroom deployment | [Month] | Materials in active use in target classrooms |
| Mid-year review | [Month] | Formative assessment data reviewed |
| End-of-year evaluation | [Month] | [Specific metric — e.g., 10% proficiency increase] |
12. Evaluation Plan
Describe how the effectiveness of this investment will be measured, by whom, and on what schedule.
| Component | Details |
|---|---|
| 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 | [SSAE Coordinator, grade-level team leads, building principal] |
| Reporting Cadence | [Quarterly progress reports to SSAE committee; annual report to LEA] |
13. Logic Model
Visual framework connecting inputs to long-term outcomes.
| Inputs | Activities | Outputs | Short-Term Outcomes | Long-Term Outcomes | ||||
|---|---|---|---|---|---|---|---|---|
| [Title IV-A 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] |
14. 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 district's SSAE 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 district's annual Title IV-A allocation."]
15. Stakeholder Consultation
Consultation conducted with: [List stakeholder groups consulted, dates, and how their input shaped the plan.]