Special Accommodations Grant (SAG) Child Development Division

Special Accommodations Grant (SAG) Child Development Division
The Agency of Human Services, Department for Children and Families, Child Development Division (referred to as the “State”) invites Vermont Regulated Specialized Child Care Programs to apply for funds to support the safe and successful inclusion of one or more children in their program.

These funds are designed to support the safe and successful inclusion, access, and participation of one or more children with identified needs in your group or classroom. You have the flexibility to apply for grant funds to purchase specialized equipment or materials, provide consultation, training, or coaching for your child care staff tailored to the child/children's needs, and/or hire an Inclusion Support Staff member. This Inclusion Support staff member will work with all children in your classroom to support the safe participation and engagement of the child or children identified in your application.

Specialized Child Care Programs (SCC) must be in compliance with their SCC Agreement and in good standing* with Vermont child care licensing regulations. SCC programs may apply on behalf of one or more children with identified needs who require additional support to access or remain enrolled in their program. Child care programs should complete the SAG application in partnership with the child’s team, which includes the child’s parent/caregiver and the professionals working together to support the child’s successful inclusion within the program.

Necessary Application Process Steps:
1. Read the Request for Grant Applications (RFGA for SAG), which provides details about timelines, eligibility requirements, required documentation, and grant specifications. You will also find detailed SAG Application guidance, which outlines essential highlights in the RFGA and is available to print out.
2. Meet with the parent/guardian to review and sign the Children's Integrated Services (CIS) SAG Parent/Guardian Consent Form. The consent form should specify the people on the child's team who will contribute information to support this application request (i.e., the provider completing the letter of support on behalf of the child). A copy of the signed form must be included with your application.
3. Please email the following SAG Service/Health Provider Letter of Support form to a service/health provider who can speak to the child’s needs. When the service/health provider completes the form, it will automatically be sent to the Child Development Division and added to your application.
Required Attachments
- CIS SAG Parent/Guardian Consent Form – Required to be uploaded for each child named in the application.
- SAG Service/Health Provider Letter of Support Form – Only needs to be upload into the application if the provider did not submit through the JotForm process and provided you with the PDF version of the form.
- Child(ren)’s Plan(s) - An active or interim One Plan, Individual Educational Plan, EST plan, 504 Plan, or Mental Health treatment plan that addresses their specialized need(s) within the past 6 months. If a child does not have a formal plan in place, the application must include supporting evidence, such as referrals made on behalf of the child, along with any screenings, assessments, or evaluations that demonstrate the child’s need for additional support.
- Certificate of Insurance – Must be consistent with the requirements outlined in Attachment C, Section 8 (Insurance), and any additional insurance requirements set forth elsewhere in the RFGA.
- W-9 IRS – Must be signed within the last six (6) months.
- Unique Entity ID (UEI) – Applicants are required to have a UEI assigned by registering on SAM.gov.
  - Suppose you have requested a UEI but have not yet received it. In that case, you will need to provide a copy of the email from SAM.gov showing that you have requested the UEI and/or the help desk email confirmation regarding any follow-up on the issuance of a UEI.
  - If your UEI is in process, please upload a signed and dated Certification of Suspension and Debarment.
  - If you have a UEI, but your SAM registration is not active, please upload a signed and dated Certification of Suspension and Debarment.
Questions and Technical Support

Please review the SAG Application Guidance for questions pertaining to the jot form application, along with guidance pertaining to the SAG application. The RFGA will explain what you will need to have ready to complete the SAG application. If you still have questions or need technical support, please join our weekly applicant information sessions (link below).

APPLICANT INFORMATION SESSIONS: A Specialized Child Care Program Administrator or Designee will be available to assist applicants every Thursday beginning August 22, 2024, from 12 to 1 p.m. unless otherwise posted.

The link to the weekly reoccurring SAG Application Hour is :

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________________________________________________________________________________

Before You Proceed with the Application
Before proceeding with the application, please note the following:
- The application could take 30 to 60 minutes to complete.
  - You can save and continue later at any time by clicking the Save button at the bottom of the page. In order to save, you will be required to create a JotForm account (if you don't already have one) using an existing Google or Facebook account, or your email.
- Please have the Required Attachments (see previous page) saved to your computer and ready to upload into this application.
Please verify the following:*

I have read and reviewed the RFGA CDD-SAG 08-19-24.I have a completed CIS Parent/Guardian Authorization Consent form for each child to be named in this application.
You cannot move forward with this application until you have reviewed the RFGA.
You cannot move forward with this application until you have received parent/guardian consent for each child named in the application. To get consent, please have the parent(s)/guardian(s) complete the CIS Parent/Guardian Authorization Consent Form.

Organization/Program Information
Point of Contact

Responsible for answering questions regarding this application information.
Point of Contact's Name*

First NameLast Name
Point of Contact's Job Title*
Point of Contact's Phone Number*
Please enter a valid phone number.
Point of Contact's Email*
example@example.com
Organization/Program
Are you applying for more than one regulated child care program?*

YesNo
Licensee Organization Name*
Enter the name of the organization or person who receives the funds/owns the program, if different from the Program Name requested below
Please enter the following for each regulated childcare program you include as part of this application.*
Does your program have a Specialized Child Care Program Status?*
If your program does not have Specialized Child Care status, please reach out to your Specialized Child Care Coordinator at the to find out more about becoming a Specialized Child Care Program. Please do not continue with this application until you have contacted your Specialized Child Care Coordinator.
Child Care Program Name*
Enter your program name as listed in BFIS or CDDIS. If you are a registered family child care home provider, list your own name (e.g., Jane Doe).
License/Certificate #*
The license number can be found on your license certificate that is posted on the wall in the program.
Program Type*
Head Start Program?*
Current STARS Rating*
Is your program a current Universal Pre-K program?*
Accepts CCFAP*
Organization/Program's Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization/Program's Mailing Address (if different than physical)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State of Vermont Vision Supplier ID*
Please see the FAQs for instructions of how to locate at https://www.vermontbusinessregistry.com/BidPreview.aspx?BidID=57470
VT Business ID #*
If you are unsure of your ID #, you can search for it on the Vermont Secretary of State's website at https://bizfilings.vermont.gov/online/BusinessInquire/.

Child(ren) Information
How many children are part of this application?*

Funding Request Details

Please provide one funding request for all the identified children in your program
What type of SAG funding are you applying for? (Please select all that apply.)*

Adaptive Equipment or MaterialsSpecialized Training/Consultation and CoachingInclusion Support Staff
Associated Costs: Adaptive Equipment or Materials
Please list specific equipment/materials. These must be specific to the child's needs (i.e., age appropriate). $500.00 Limit*
Equipment/Materials

Specifications: Equipment and materials should directly support the inclusion and development of children with identified needs. The following categories outline acceptable use of grant requests up to $500.00 per application. The equipment and /or must remain in the child care program after the grant period ends to support overall inclusion of children with identified needs.
Total Amount Requested for Equipment/Materials (Not to exceed $500.00) - (This field is automatically calculated.)
How will the equipment or materials support the program in meeting the child(ren) plan goals for successful inclusion in the program?*
How do these additional supports increase inclusive practices in your child care program for all children?*
Specialized Training/Consultation
Please list the specific trainings/consultations or coaching. IMPORTANT: This cannot occur outside of the approved grant award term.*
Total Amount Requested for Training/Consultation or Coaching (Not to exceed $500.00) - (This field is automatically calculated.)
Inclusion Support Staff

The following calculations are
Who would be directly responsible for supervising the inclusion support staff hired with these funds?*
Supervision Plan for Inclusion Support Staff: Please provide a detailed plan outlining how the Inclusion Support Staff will receive training and supervision throughout the grant term. This plan should be developed collaboratively with the child’s or children’s support team and should clearly demonstrate how the Inclusion Support Staff will implement strategies that ensure the child receives support alongside their peers throughout the grant period*

Number of inclusion support staff.*
Proposed Start Date (An application's proposed grant start date can't be prior to the current RFGA round submission deadline. See SAG Guidance) *

MonthDayYear
Proposed End Date - (An application's proposed end date can't exceed 12 months)*

MonthDayYear
Total hours description: (This is the total hours planned during the grant term for each inclusion support staff. If the hours vary based on season (ie. school and summer), please show the differences. For example, ( 15 hrs per school season week x 40 weeks + 35 hrs per summer season week x 12 weeks = 1020 hours.):*
Staff 1 - Hourly Rate of Pay
Staff 1 - Enter the total hours you are requesting for staff during the grant term.
Staff 1 - Total amount requested for staff
Staff 2 - Hourly Rate of Pay
Staff 2 - Enter the total hours you are requesting for staff during the grant term.
Staff 2 - Total amount requested for staff
Staff 3 - Hourly Rate of Pay
Staff 3 - Enter the total hours you are requesting for staff during the grant term.
Staff 3 - Total amount requested for staff
Staff 4 - Hourly Rate of Pay
Staff 4 - Enter the total hours you are requesting for staff during the grant term.
Staff 4 - Total amount requested for staff
Total number of inclusion support hours (this is the total hours planned during the grant period for all inclusion support staff) (This field is automatically calculated.)
Total Amount Requested for Inclusion Support Staff (This field is automatically calculated.) *
Fringe benefits cost for inclusion support staff: (allowances and services provided by employers to their employees as compensation in addition to regular salaries/wages. Fringe benefits include, but are not limited to, the costs of leave [vacation, family-related, sick or military], employee insurance, pensions, and unemployment benefit plans.) Enter 0 if not requesting fringe*
Please estimate indirect costs (costs associated with supporting the organization that may not directly relate to service delivery [your organization’s accountant or IT security provisions are good examples.] Indirect costs may not exceed 10% of modified total direct project costs unless the organization has a federally approved indirect cost rate letter indicating a different rate. Enter 0 if not requesting an indirect cost.*
*If you are using a federally approved indirect cost rate, please submit a copy of the letter with your application.
Total SAG Funding Amount Requested From CDD (This field is automatically calculated.)

Certification & Submission
By submitting this application, you certify to the following:
- The information provided on this application is true and accurate.
- I understand that the information provided on this application may be verified by other programs, such as Child Care Licensing, Child Care Financial Assistance Program and AHS prior to a grant award being issued.
- I agree that, as the Applicant, I must repay the grant or portion of the grant to the CDD if any grant funds received are based on incorrect representations made on this application or to the State related to this application.
Signature*

Clear
Job Title (Person Signing Above)*
Name*

First NameLast Name
Address of Signature Signing Above: *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Important! Please read.

If you want a copy of your entire submission, you MUST click the Print button below before you click the Submit button. The confirmation email you receive once you hit submit will not contain any HIPAA-related information.

Please Note: If you print or save the application, you are responsible for ensuring HIPAA compliance.
Should be Empty:

	Monday hours	Tuesday hours	Wednesday hours	Thursday hours	Friday hours
Early Childhood Education Program
Afterschool Program

	Monday hours	Tuesday hours	Wednesday hours	Thursday hours	Friday hours
Early Childhood Education Program
Afterschool Program

	Monday hours	Tuesday hours	Wednesday hours	Thursday hours?	Friday hours
Early Childhood Education Program
Afterschool Program

	Monday hours	Tuesday hours	Wednesday hours	Thursday hours?	Friday hours
Early Childhood Education Program
Afterschool Program

Age of Child(ren)	Allowable hours per week funded by SAG award
0-2	35 hours
3-5	38 hours
6-13	15 hours afterschool /or up to 38 for school vacations, including summer

Special Accommodations Grant (SAG) Child Development Division

Necessary Application Process Steps:

Required Attachments

Questions and Technical Support

Before You Proceed with the Application

Organization/Program Information

Point of Contact

Organization/Program

Child(ren) Information

Child 1

Child & Family Information

Learning About The Child-1

Child 1- Schedule

Learning About the Child-1

Child's Support Team

Child 2

Child & Family Information

Learning About Child 2

Child 2- Child Care Schedule

Child's Support Team

Child-3

Child 3 & Family Information

Learning About the Child -3

Child 3- Child Care Schedule

Child's Support Team

Child 4

Child 4 & Family Information

Learning About the Child

Child 4- Child Care Schedule

Child's Support Team

Funding Request Details

Associated Costs: Adaptive Equipment or Materials

Specialized Training/Consultation

Inclusion Support Staff

Additional Requirements

SAM.Gov Information

Risk Assessment

Exceptions to the Standard State Granting/Contracting Provisions

Required- Certificate of Insurance

Required -W-9 Form

Certification & Submission