2017 Mini Grant Program Guidelines and Application

COVER SHEET:

submit this page with the original application

LOCAL AGENCY:

School Name:

School Name:

School Name:

Check each box to ensure the following components are included in the proposal:

Application Cover Sheet	Letter of Endorsement from School District

Application, Sections I-V	Supporting letters (e.g. principal, non-profits)

Budget (spreadsheet format)	Mayor’s Original Signature

Submission Requirements:

Please submit the original application, five (5) copies, and one (1) CD copy to:

Diana Benedict, Program Coordinator

Tennessee Department of Transportation

James K. Polk Building

505 Deaderick Street, Suite 600

Nashville, TN 37243-0334

Phone: (615) 253-2421 Fax: (615) 741-9673

Email: Diana.Benedict@tn.gov

Deadline for 2017 Submittals:

January 31, 2017 at 2:00 p.m. (CST)

TDOT Safe Routes to School (SRTS) Program Mini Grant Program Informational Page The SRTS Mini Grant Program provides assistance to schools and community groups to offer organized initiatives that support physical activity, education and encouragement for walking and biking to school safely. Each school will develop a School Activity Plan (sometimes referred to as non-infrastructure activities). This written document outlines a school community's intentions to address safety, physical activity, and healthy initiatives to promote and facilitate walking and/or bicycling to and from school. The Plan provides the ability to create a personalized document that is unique to a particular school and/or community. The goal is to teach safety education and healthy habits by identifying opportunities and creating partnerships between the schools, students, local officials, transportation officials, law enforcement, health advocates, community, and other interested partners. The Plan provides a variety of choices as determined by a school and/or community addressing travel situations, barriers and solutions. Request Limit: Maximum of $5000 per school. Eligible Recipients: All elementary and middle schools, public and private, are eligible to apply for this program based on Federal criteria. Eligible Applicants: Local Governments (city or county with jurisdiction over the school). Federal Requirements: Legislation specifies that the Federal share of this activity shall be 100% up to the approved amount. No funding match is permitted. Project Eligibility: Funds can be used for planning, education, and promotion of SRTS activities and a variety of programs including, but not limited to: student safety patrol, pedestrian education campaigns, Walk to School Day events, Bike to School Day events, Walking School Bus Programs, Bike Train Programs, bicycle safety skills events, and traffic safety activities. Support and Acknowledgements: A letter of Endorsement from the school district must be included. Attach letters of support from school principals, local officials, bike clubs, non-profits, etc. Important Dates: November 1-4, 2016 SRTS Mini Grant Training Workshops January 31, 2017 SRTS Mini Grant Applications Due Resources: www.saferoutesinfo.org www.nhtsa.gov/childpedestriansafetycurriculum www.walkingschoolbus.org Send proposals and direct questions to: Diana Benedict, Safe Routes to School Coordinator 505 Deaderick Street, 6th Floor, Polk Building Nashville, TN 37243 Diana.Benedict@tn.gov 615-253-2421
2017 SAFE ROUTES TO SCHOOL (SRTS) PROGRAM Mini Grant Application
A P P L I C A N T (City or County):	Mayor:
Address:
Contact Person:	Title:
Email:	Phone:	TDOT Region:
Activity:	Total Funding Request Amount:
SCHOOL NAME:
Address:	School District:
Principal Name:	Phone:
Current # of Students Enrolled:	% Economically Disadvantaged Students:	Title 1 School: Yes or No	Type of School: Elementary or Middle
Approx # of students who live within a two-mile radius of the school:	Approx # of students who live within a one-mile radius of the school:	Approx # of students who live within a 1/2-mile radius of the school:	____________
Approx # of students who regularly walk to school:	Approx # of students who regularly bike to school:	Approx # of students who regularly ride the bus to school:	Approx # of students who regularly ride in a car/van to school:
SCHOOL NAME:
Address:	School District:
Principal Name:	Phone:
Current # of Students Enrolled:	% Economically Disadvantaged Students:	Title 1 School: Yes or No	Type of School: Elementary or Middle
Approx # of students who live within a two-mile radius of the school:	Approx # of students who live within a one-mile radius of the school:	Approx # of students who live within a 1/2-mile radius of the school:	____________
Approx # of students who regularly walk to school:	Approx # of students who regularly bike to school:	Approx # of students who regularly ride the bus to school:	Approx # of students who regularly ride in a car/van to school:
SCHOOL NAME:
Address:	School District:
Principal Name:	Phone:
Current # of Students Enrolled:	% Economically Disadvantaged Students:	Title 1 School: Yes or No	Type of School: Elementary or Middle
Approx # of students who live within a two-mile radius of the school:	Approx # of students who live within a one-mile radius of the school:	Approx # of students who live within a 1/2-mile radius of the school:	____________
Approx # of students who regularly walk to school:	Approx # of students who regularly bike to school:	Approx # of students who regularly ride the bus to school:	Approx # of students who regularly ride in a car/van to school:
ATTACH ADDITIONAL PAGES AS NECESSARY

SECTION 1: WORK PLAN
1A. Attach the School Activity Plan. A successful Plan is a partnership between the local agency, schools, community organizations, neighborhoods, and local officials that work together to create opportunities to make walking and biking to school fun, easy, and healthy for everyone. Include events/ideas that promote organized initiatives to encourage students to walk, bike, or use other means of physical activity to get between home and school safely. Program should include a timeline and may include a pedestrian and/or bike safety education component. (500 words or less)
1B. What is the goal of the program (i.e., does the program aim to create a sustainable local SRTS program, and/or does the program support and enable walking and bicycling to and from school?) (200 words or less)
1C. What is the approximate number of students who will benefit from this proposal? Will the activities described allow for participation by students with disabilities? If yes, please describe. (200 words or less)
SECTION 2: PARTICIPATION AND ENCOURAGEMENT
2A. Indicate who will be involved with the program’s activities, including (if possible), the school staff, local officials, consultants, etc. List any participants (e.g. enforcement officials, teachers, organizations) that may actively support or participate in the program. (200 words or less)
2B. Describe the roles/responsibilities required for the implementation of the proposed program. (200 words or less)
2C. How will the students be encouraged to use active transportation or engage in physical activity. (200 words or less)
SECTION 3: FUTURE VISIONING
3A. What is the short term goal for the program? State how you vision the program will grow, and how you may obtain funding and/or program volunteers to continue the program in the future. (200 words or less)
3B. If your school is a prior Safe Routes to School recipient, describe how additional funding will help to continue and grow the program. List factors such as: new initiatives, number of students targeted, previous program initiatives, challenges, etc. Include any success stories and strategies used to overcome obstacles with retaining the interest of students, volunteers, and school officials. (200 words or less)
SECTION 4: EVALUATION Awardees must be prepared to complete quarterly progress reports.

4A. How will the success of the program be measured? Include the following indicators if possible: increased number of students using alternative transportation, decreased traffic congestion around the school grounds, increase in local law enforcement partnerships, increase in the number of safety educational programs at the school, etc. (200 words or less)
4B. The school will be required to complete SRTS surveys (www.saferoutesdata.org). Describe how the program will be monitored and adjusted for changes in participation. State strategies to address low levels of participation if necessary. (200 words or less)
SECTION 5: BUDGET
Attach a spreadsheet (per school) for items needed to complete your activities/events (i.e., include the item description, unit price, quantities, total cost, etc.). Schools and communities have the best chance of success when they combine expertise, resources, and program elements that consider four of the E’s for Safe Routes to School (i.e., Encouragement, Education, Enforcement, and Evaluation). Below are examples of items that can and cannot be purchased based on federal and state guidelines. Please note that these lists are not exhaustive. Because of the small award size, these restrictions may differ slightly from those associated with the regular TDOT Safe Routes to School non-infrastructure grants. If you have questions about funding eligibility for specific activities or items, please email: diana.benedict@tn.gov.
Examples of Eligible Mini Grant Items: ~ Promotional and educational materials ~ Professional services (e.g. consultant or safety trainers) ~ Safety items (e.g. reflective vests/belts, bands, neon whistles) ~ Bicycle helmets ~ Educational curricula ~ Hand-held safety signs ~ Modest incentives for student encouragement/participation ~ Walk and Bike to School Day banners ~ Mileage programs	Examples of Ineligible Mini Grant Items: ~ Food and refreshments ~ Staff salaries or stipends for volunteers ~ Fundraising activities ~ Gift cards ~ Bicycles or bicycle racks ~ Security cameras ~ Infrastructure improvements (e.g. sidewalk construction, crosswalk installation, traffic signs/signals)
Applications must be signed by the City or County Mayor (the highest elected official of a local governmental agency must sign the application – stamped signatures not acceptable) SIGNATURE: Signature: _________________________________________________________________ Date: ___________________ City or County Mayor Printed Name and Title of Elected Official: ,