Activity Proposal Form
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1
2st
21
Century Community Learning Center
FORM
ACTIVITY PROPOSAL
School Site________________________
(Please complete this form for each activity proposal.)
Name of Activity Proposal:
(check one)
Core Academic (65%)
Enrichment (35%)
(check all that apply)
Math
Reading
Science
Tech/Library
Fine Arts
Recreation/Nutrition
Youth/Family
Activity Description:
State Standards:
Proposal Date(s) of Activity:
Grade(s) of students to be served:
1.
Activity hours:
Day total hours:
(begin)
(end)
2.
Days of the Week:
Mon.
Tues.
Wed.
Thurs.
Fri.
Sat.
Sun.
(check)
3.
Number of Weeks:
Total Hours of Activity:
(1.number of hours x 2.number of days x 3.number of weeks = ?)
(total hours)
Activity Costs:
Salary:
$25.00 x
(total hours)
x
(# of teachers)= $
(teacher)
$15.00 x
(total hours)
x
(# of paras) = $
(para)
Benefits:
$
7.65 % FICCA & 24.5% TFFR =
TEACHER: multiply 32.15% =
$
7.65% FICCA
PARA:
multiply 7.65% =
Bus Mileage:
miles x 1.70 per mile =
$
Equipment:
$
(describe)
Supplies:
$
(describe)
TOTAL ACTIVITY COST: $
predicted
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