Title III Pre-Approval Form
Date
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Month
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Year
2 digit month, 2 digit day, 4 digit year
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District/School:
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Name submitting the form:
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Email
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example@example.com
Title of Request:
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Total Cost:
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Is the total cost over $13,200.00?
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Yes
No
Due to the cost of the request and procurement guidelines, please upload your three quotes:
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Select which approved Title III activity your request falls under:
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1. Providing effective language instruction educational programs (LIEPs) that meet the needs of ELs and demonstrate success in increasing English language proficiency and student academic achievement.
2. Providing effective professional development to classroom teachers (including teachers in classroom settings that are not the settings of LIEPs), principals and other school leaders, administrators, and other school or community-based organizational personnel; that is:
Designed to improve the instruction and assessment of ELs
Designed to enhance the ability to understand and implement curricula, assessment practices and measures, and instructional strategies for ELs
Effective in increasing children's English language proficiency or substantially increasing the subject matter knowledge, teaching knowledge, and teaching skills of such teachers: and
Of sufficient intensity and duration (which shall not include activities such as one-day or short-term workshops and conferences) to have a positive and lasting impact on the teachers' performance in the classroom
3. Providing and implementing other effective activities and strategies that enhance or supplement language instruction educational programs for ELs, which must include parent, family, and community engagement activities, and may include strategies that serve to coordinate and align related programs.
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Please read and respond to the following statements:
The LEA affirms that all Title III funds and resources requested will be used only to supplement, and not supplant, state, local, or other federal funds that, in the absence of such funds, would otherwise be expended to provide programs and services for English Learners (ELs) (ESEA, Title III, Section 3115(g)).
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Please Select
Yes
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The LEA further affirms that all Title III funds and resources requested will not be used to replace or supplant the core language instruction educational program, materials, or services for English Learners, which the LEA is required to provide pursuant to Title VI of the Civil Rights Act of 1964, and that such funds will be used solely to enhance or supplement services for ELs (ESEA, Title III, Sections 3115(a) and 3121(a)).
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Please Select
Yes
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The LEA affirms that all Title III-funded goods or services requested adheres to federal procurement threshold guidance and required competitive procurement procedures, as applicable (ESEA, Title III; 2 CFR §§ 200.317-200.326).
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Please Select
Yes
No
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Please answer the following questions as they relate to this proposed activity:
How many ELs will be impacted by this request?
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Signature
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Payment processing options:
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I am requesting pre-payment for this activity (purchase request).
I will request reimbursement after the activity.
Purchase request form:
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