American Indian Education Centers:

Tobacco-Use Prevention Education Program

Continuing Application

October 1, 2016–September 30, 2017

APPLICATION DEADLINE:

Monday, September 12, 2016

Applicant’s Name: ______

Educational Options, Student Support,

and American Indian Education Office

California Department of Education

1430 N Street, Suite 6408

Sacramento, CA 95814-5901

Signature Page
Purpose: This page is to declare that the American Indian Education Center (AIEC) is hereby applying for funds for the Tobacco-Use Prevention Education Program. Funds provided through this application are primarily for the purpose of developing prevention education, intervention, cessation, and youth development programs directed at the reduction of commercial tobacco-use among students.
This page must be signed by the Board Chairperson or Designee. / Name of AIEC:
Please return an original to:
Educational Options, Student Support, and American Indian Education OfficeCalifornia Department of Education
1430 N Street, Suite 6408Sacramento, CA95814-5901Electronic mail or facsimile submissions will not be accepted. / Dates of Project Duration:
October 1, 2016, to September 30, 2017
Contact Person: / Center Director: / Please indicate the Budget Requested
(not to exceed $60,000 per year)
Title: / Title: / $
Address: / Address:
City/Zip Code: / City/Zip Code:
Telephone: / Telephone:
Fax: / Fax:
Internet Site/E-Mail Address: / Internet Site/E-Mail Address:
Certification: I hereby certify that this AmericanIndianEducationCenter will adhere to all the assurances and that this center intends to fully implement the program as described in this application.
Name of Board Chairperson or Designee: / Signature of Board Chairperson or Designee: / Date:

American Indian Education Center

Tobacco-Use Prevention Education Program

Continuing Application

  1. Purpose

The purpose of this American Indian Education Center (AIEC) Tobacco-Use Prevention Education (TUPE) Program Continuing Application is to continue support for the AIEC-TUPE grants to implement supplemental prevention education, intervention and cessation programs, and youth development programs directed at the reduction of commercial tobacco use among youth.

The continuing programs must:

  • Implement research-validated TUPE programs.
  • Target current smokers and students most at risk for beginning to use commercial tobacco.
  • Offer cessation and pre-cessation classes or refer students who are current smokers to cessation classes.
  • Utilize existing antismoking resources, including local antismoking efforts by local lead agencies and competitive grant recipients.
  1. Background

Tobacco use is the most preventable cause of death and disease today. The Centers for Disease Control and Prevention reports that in California 14 percent (age eighteen-plus years) over 3,839,000 individuals are current smokers, and there is a 6.9 percentage prevalence of current smoking among youth. Tobacco use costs the California economy more than $18.1 billion in health-related expenses and lost productivity.

Native Americans in California smoke and chew tobacco twice as much as do other Californians. In California, 27.4 percent of Native Americans smoke. The use of tobacco is one of the most preventable causes of illness and premature death among Native Americans. Native Americans/Alaskan Natives have the highest rate of tobacco use among all ethnic groups.

Proposition 99, approved by the California voters in the November 1988 general election, increased the tax on each pack of cigarettes sold in the state by 25 cents.

The 1988 legislation requires that 90 percent of the funds received for local assistance be allocated to county offices of education and public school districts for programs in schools. Additionally, funding for commercial tobacco-use prevention, intervention, and cessation programs in AIECs is to be awarded on a competitive grant basis.

Successful tobacco-use prevention, intervention, and cessation programs are an important part of this effort and an effective weapon against four of the five leading causes of death in California: heart disease, cancer, chronic obstructive pulmonary disease, and fires caused by smoking.

  1. Grant Award Amounts

The total amount of funding anticipated to be available for the Continuing Application for commercial tobacco-use prevention, intervention, and cessation programs for students in AIECs is $300,000 each year of the five-year cycle, subject to the availability of funds and the performance of the grantee. Grant awards will not exceed $60,000 per year per grantee. Grant funding requests must be based on cost of the planned activities described in the Continuing Application.

  1. Grant Funding Period

The Continuing Application grant funding cycle will be October 1, 2016, through September 30, 2017. Continuing applicants will submit an annual program description and budget each year.

  1. Continuing Application Instructions

Please complete all sections of this application on singlesided, 8½- by 11-inch paper, using 12-point Arial font, with half-inch margins:

  1. Overall Program Goals and Measurable Objectives
  1. Program Description, Including Multiple Strategies and Selected Strategies Rationale
  1. Projected Key Activities and Timelines
  1. Personnel

Include all budget forms:

  • Budget Summary (Appendix 1)
  • Budget Detail (Appendix 2)
  • Budget Narrative (Appendix 3)

Each AIEC-TUPE Continuing Application must be stapled or clipped in the upper left-hand corner with the Application Cover Sheet on the top of the application. Do not use binders, covers, flat folders, or cover letters.

The continuing applicant is responsible for ensuring that the application package is complete and that there are no missing pages/forms prior to submission. The California Department of Education (CDE) cannot add items to or remove items from the applications received.

An original AIEC-TUPE Continuing Application (with original signatures) must be received by the CDE no later than 4 p.m., Monday, September 12, 2016.

Transmission of applications by electronic mail (e-mail) or facsimile is not allowed. The application must be titled:

Tobacco-Use Prevention Education Program Continuing Application

Applicants should mail application to:

Judy Delgado, American Indian Education Consultant

Educational Options, Student Support, and American Indian Education Office

California Department of Education

1430 N Street, Suite 6408

Sacramento, CA 95814-5901

The CDE reserves the right to reject any or all applications. The state's waiver of any submission of material not required in the AIEC-TUPE Continuing Application does not excuse the grantee from full compliance with the grant terms, if a grant is awarded.

  1. Program Assurances

The Board Chairperson or Designee’s signature on the Signature Page signifies acceptance of these assurances.

The applicant Center provides an assurance that the AIEC will have met the commercial tobacco-free criteria on or before October 1, 2016, and is not receiving or planning to receive funds and promotional consideration or support of any kind from the tobacco industry. A fully implemented Commercial Tobacco-Free Policy must be board-adopted and include the following:

  • The policy shall prohibit the use of commercial tobacco products at any time on the AIEC premises and in AIEC vehicles. Information about the policy and enforcement procedures shall be communicated clearly to AIEC personnel, parents, students, and the larger community.
  • Signs stating “Commercial Tobacco Use Is Prohibited” shall be prominently displayed at all entrances to AIEC property; and information about smoking cessation support programs shall be made available and encouraged for students and staff.
  • The AIEC provides an assurance that a systematic and ongoing process to collect data to ensure that the program resulting from the grant process is being implemented as planned and that the data will be used to measure the effectiveness of the program in achieving its expected results.
  • The AIEC will maintain accurate student data.
  • The AIEC provides an assurance that the AIEC intends to fully implement the program described in this application.

The AIEC provides assurance that all required reports will be provided to the Educational Options, Student Support, and American Indian Education Office of the CDE.

General Assurances and Certifications are requirementsof grantees as a condition of receiving funds. Applicants do not need to sign and return the General Assurances and Certifications with this application; instead, they must download the current General Assurances and Certifications (2016–17) and keep them on file. Refer to the Assurances and Certifications located on the CDE Funding Tools & Materials Web page at

  • General Assurances form:

Successful continuing applicants will automatically receive a 50 percent payment upon satisfactorily addressing any program and/or budget stipulations (providing the current year state budget has allocated adequate funds and the budget has been signed by the Governor) and upon acceptance of the grant conditions.

The grantee can receive another 40 percent payment by submitting to the CDE an Expenditure Report indicating that 80 percent of the prior 50 percent has been expended.Continuing applicants must be current on all required reports before any payments can be processed.

The final 10 percent, or portion thereof, will be held pending receipt of the End-of-YearProgram Report, Evaluation Report,Inventory Form, and the final Expenditure Report, all of which are due within 45 days of the grant termination date.

The AIEC will submit the following required deliverables by 5:00 p.m. on the designated due dates:

Expenditure Report Due Dates / Report Period
February 10, 2017 / October 1, 2016–December 31, 2017
May 11, 2017 / January1, 2017–March 31, 2017
August 11, 2017 / April 1, 2017–June 30,2017
November 10, 2017 / July 1, 2017–September 30,2017
End-of-Year Report Due Date / Report Period
November 14, 2017 / October 1, 2016–September 30, 2017
  1. Measurable Objectives

Please list the 2015–16 approved measurable objectives. These measurable objectives can be found in your 2015–16 application. If you are making changes, note in bold, and if you are making deletions, please use strikeout. Justification for changes must be included.

Please list at least onemeasurable objective and include both program implementation (e.g., number of hours of instruction and number of students receiving instruction) and student outcome objectives (e.g., percentage decrease in number of students who smoke) for each of the three target groups: (1) General Population, (2) Most At Risk, and (3)Current Users.

  1. Program Description

Please describe your program, including the 2015–16 approved strategies. These strategies can be found in your 2015–16 application. If you are making changes, note in bold, and if you are making deletions, please use strikeout. Justification for changes must be included.

Discuss the program strategies for each target group: (1) General Population, (2) Most At Risk, and (3) Current Users. Please include a description of:

  • Selected curriculum
  • The title, year of publication, and publisher of the program or materials to be used
  • How the proposed curriculum meets the identified need of the student population to be served
  • Delivery methods
  • Means of identifying students to be served
  • Number of students to be served
  1. Projected Key Activities and Timelines

Please list the 2015–16 approved key activities and timelines. These key activities and timelines can be found in your 2015–16 application. If you are making changes, note in bold, and if you are making deletions, please use strikeout. Justification for changes must be included.

Provide the projected key activities and timelines for the entire grant period to include the three target groups: (1)GeneralPopulation, (2) Most At Risk, and (3) Current Users.

  1. Personnel

Please list the 2015–16 personnel. A list of personnel can be found in your 2015–16 application. If you are making changes, note in bold, and if you are making deletions, please use strikeout. Justification for changes must be included.

Provide the names (when possible) of all key staff personnel involved in implementing the program and specific program responsibilities.

  • Identify key personnel involved in implementing the program. Include the job description and resume for each position. If personnel are not changing and these documents are on file with the original approved application, simply note, “On file with original application.”
  • Describe program responsibilities for key personnel.
  • Indicate the amount of time each key staff person will spend implementing the program in full-time equivalent or number of hours to be worked.
  1. Budget

Budget Limitations

The purchase of property or equipment is not allowed with these funds. The purchase of food is not an allowable expense under the TUPE Program (except if absolutely necessary in order to implement a strategy which is conducted beyond normal school hours such as precessation and cessation programs or other training events held after school, off-site, during summer sessions, and/or on Saturdays). Out-of-state travel by a grantee for purposes of this grant is not allowed. Any item that is not in the approved budget is unallowable unless written approval is given in advance by the CDE.

If indirect costs are claimed, an indirect cost allocation plan must be on file with the grantee and available for review by CDE staff. The maximum for an indirect cost rate for this funding is 7 percent. This rate is applied to budget categories 1000–5000 only in determining the maximum amount of indirect costs that are reimbursable under the grant. Indirect costs include agency-wide costs for fiscal services, personnel, centralsupport (e.g., bookkeeping, purchasing, warehousing, and printing), and other centralized services.

  • The amount of cost allocable to this grant shall not exceed the benefits to this grant. The allocation method must quantify this benefit among all similar programs and then distribute the costs accordingly.
  • The indirect cost rate shall not include consideration of any costs otherwise non-reimbursable. If a depreciation or use allowance is included in the indirect cost rate, such allowance shall not be claimed on the asset.

1