/ Los Angeles Region FIRST LEGO League
Application for Rockwell Collins Grants
2010Body ForwardSeason
Newand Second-Year FLL TeamsPage 1 of 4 /

Thank you for your interest in FIRST LEGO League. Funding has been set aside under the terms of a grant from Rockwell Collins through a donation to FIRST for a limited number of new and second-year FLL teams from the Los Angeles Region of Southern California, which includes Los Angeles, Ventura, Santa Barbara and San Luis Obispo counties. The grant is intended to establish FLL teams in economically and/or socially disadvantaged schools or communities. Primary consideration will be given to teams from zip codes with median household income less than 80% of the state per city-data.com and/or teams from schools with a free/reduced meal population of 40% or more. Special consideration will be given to teams of underrepresented minorities and females and to teams from rural schools. Additional consideration will be given to teams with 5 or more student members and to teams formed through a school, non-profit organization (e.g., Girl Scouts, Boy Scouts, Boys & Girls Club, 4H), or public center (e.g., library, community center). Grants are also available to teams that have a Rockwell Collins employee or retiree as a coach or mentor. In order to create sustainable FLL teams, teams receiving the grantsare responsible for paying a portion of their own FLL team costs. For example, all teams will need to purchase a Field Setup Kit and project presentation materials and register for a Qualifying Tournament; the estimated unreimbursed annualteam costsare $125-$350. Teams will be expected to complete payments for team registration and Field Setup Kit promptly after receiving grant approval if they have not done so already.

New Team Support

For new teams, grant funds will reimburseFLL team registration and one FLL MINDSTORMS NXT robot set; the estimated cost including shipping and sales tax is $692. New teams will be responsible for paying for these items plus the Field Setup Kit directly to LEGO Education; the estimated total costis $767. New teams may also need to build a challenge field table; the estimated cost of materials is $30-$70.

Second-Year Team Support

Teams that received New Team Support the previous year are eligible to apply for Second-Year Team Support. For second-year teams, grant funds will reimburse FLL team registration; the estimated cost including shipping and sales tax is $233. Teams will be responsible for paying for team registration plus the Field Setup Kit directly to LEGO Education; the estimated total cost is $308.

Team Support Reimbursements

Reimbursements will be paid upon successful completion of the requirements below. Teams with financial hardships can request that payment be made directly to LEGO Education, although additional approvals will be required. If requesting direct payment, order the team registration and robot set together, and indicate that you will pay by check; order a Field Setup Kit and other items separately.

Grant Recipients must commit to the following requirements:

1.This FLL team is registered with California – Los Angeles as its Primary Region.

2.This is a new team or the team received team support last year.

3.The team has ten or fewer team members, andall were between the ages of 9 and 14 on January 1, 2010.

4.The team will meet weekly for at least two hours per week for at least eight weeksin September, October and November.

5.Coaches will sign and abide by the FLL Coach’sPromise (included inFLL Coaches’ Handbook).

6.Coaches will participate in a FLLChallenge release workshop or coach training workshop for at least two hours. Workshops will bescheduledat various locations between Mayand October. See the Event Schedule at LARFLL.org.

7.The team will participate in a Los Angeles Region FLL qualifying tournament.

8.The coach will be responsible for managing the team as outlined above and for a post-season evaluation.

9.The coach and the team’s school/organization agree to maintain awarded robot sets in useable condition and to make them available for use by an FLL team for at least two years. If the school/organization does not continue with the FLL program for at least two years, the robot set must be returned to Los Angles Region FLL.

10.The coach must submit copies of receipts from LEGO Education in order to receive team support reimbursement.

New and Second-Year Coach Stipends

Paid school employees (i.e. teacher, counselor) or staff members of a qualified nonprofit organization who are serving as coach for one or more FLL teams receiving team supportmay be eligible for a stipend of $500 for new coaches and $250 for second-year coaches. Payment of the stipend is contingent on receipt of IRS Form W-9. The stipend will be paid after the team has completed the requirements above.

Application Due Date

Completed applications must be e-mailed to bySeptember 15, 2010.Applications will be considered in the order they are received. Decisions will usually be e-mailed to teams within one week. Decisions for teams that do not meet either economic eligibility criterion will be deferred until the due date.

Coach Information

First Name: Last Name

Daytime phone: () - Cell Phone: () -

Work email address:

Homeemail address:

Team Information Note: Check boxes below by changing properties.

Number of students on team: Team number: (must be registered)

School or Organization Name:

Team Affiliation: School Boy Scouts Girl Scouts Boys & Girls Club 4-H

Other non-profit organizationOther (please specify):

Grant Eligibility

Lowmedian householdincome (zip code less than 80% of state per city-data.com, please specify): %

High percentage of free or reduced lunch status (more than 40%, please specify): %

Under-represented minorities. Please specify number of Under-represented minority students on team:

Mostly female.Please specify number of female students on team: Rural school

Team has a Rockwell Collins employee or retiree as a coach or mentor.

Name of Rockwell Collins mentor:

Email of Rockwell Collins mentor:

Financial hardship. Direct payment to LEGO Education is requested. Fax additional approval on Page 4.

Coach stipend requested. Please submit IRS Form W-9after the stipend is approved.

Team Support Reimbursement Information

Name of payee for reimbursement check:

Mailing Address:

City: State: CAZip code:

Short Essay Questions

Please type responses to each of the following questions in 100 words or less.

How will the team be formed, including gender and ethnicity considerations?

Why does the team need funding in order to participate in FLL?

What does the team hope to achieve through participation in FLL?

Coach Agreement

If this application is approved, I will be responsible for managing the team as indicatedin this application and for participating in a post-season evaluation. My organization and I agree to maintain awardedFLL MINDSTORMS NXT Robot Sets in useable condition and to make them available for use by an FLL team for at least two years. If my organization does not continue with the FLL program for two years, I understand that I must return the Robot Setto Los Angeles Region FLL. I have entered my full name below as my electronic signature to indicate my agreement to these conditions.

Electronic signature:

Date signed:

Additional Approval Required for Financial Hardship Direct Paymentof New Team Support

This page only needs to be completed if the coach has claimed financial hardship and has requested direct payment to LEGO Education instead of reimbursement. This form is to be signed by the Principal or equivalent manager of the school or organization applying for a Team Support Grant from Rockwell Collins.

Please fax the signed form to LeRoy Nelson, Los Angeles Region FLL at310-937-1416.
No cover sheet is needed.

Name of Coach Team number:

School or Organization Name:

Mailing Address:

City: State: CAZip code:

Organization Agreement

I am the principal or equivalent manager of the school or organization listed above. I have reviewed this grant application, and I believe that all of the information provided is accurate.

I agree that this school or organization faces a financial hardship that prevents us from paying the total cost of FLL Team Registration, FLL MINDSTORMS NXT Robot Set and Field Setup Kit (estimated total cost is $767) by September 30. I understand that this grant, if approved, would pay for the FLL Team Registration and Robot Set (estimated total cost is $692). I understand that my organization will be responsible for paying for the Field Setup Kit andmaterials to build a Challenge Field Table by September 30 (estimated cost is $106-146) and for project presentation materials and qualifying tournament registration by October 31 (estimated cost is $50-200).

I understand that my school or organization is responsible for maintaining awarded robot sets in useable condition and for making them available for use by an FLL team for at least two years. If my school or organization does not continue with the FLL program for two years, I understand that we must return the robot set to Los Angeles Region FLL. I agree to these conditions.

Signature of Principal or manager:

Name of Principal or manager:

Title of Principal or manager:

Date signed: Phone: () - Fax: () -

Email address:

For questions about grants or FIRST LEGO League, please contact LeRoy Nelson, Operational Partner,

Los Angeles Region FIRST LEGO League (LARFLL) by email or by phone 310-937-7226.